Penetrating Neck Injuries, Management of
Published 2008
Published 2008
Selective operative management and mandatory exploration of penetrating injuries to Zone II of
the neck are equally justified and safe.
No recommendations.
No recommendations.
No recommendations.
CT angiography or duplex ultrasonography can be used in lieu of arteriography to rule out an
arterial injury in penetrating injuries to Zone II of the neck.
CT of the neck (even without CT angiography) can be used to rule out a significant vascular
injury if it demonstrates that the trajectory of the penetrating object is remote from vital
structures. With injuries in proximity to vascular structures, minor vascular injuries such as
intimal flaps may be missed.
No recommendations.
Either contrast esophagography or esophagoscopy can be used to rule out an esophageal
perforation that requires operative repair. Diagnostic workup should be expeditious because
morbidity increases if repair is delayed by more than 24 hours.
No recommendations.
No recommendations.
No recommendations.
1) Careful physical examination, including auscultation of the carotid arteries, is >95% sensitive
for detecting arterial injuries that require repair. Given the potential morbidity of missed injuries,
imaging is still recommended.
2) Physical examination is inadequate to rule out injuries to the aerodigestive tract.
No recommendations.
1) Except for minimal intimal irregularities or small pseudoaneurysms without neurologic
deficits, penetrating injuries to the internal carotid artery should be repaired, even when severe
neurologic deficits are present.
2) Angiographic approaches to the vertebral artery are preferred to operative approaches for
patients with bleeding from vertebral artery injuries.
3) Ligation of the jugular vein is appropriate for complex injuries or unstable patients.
No recommendations.
No recommendations.
Immobilization of the cervical spine is unnecessary unless there is overt neurologic deficit or an
adequate physical examination can not be performed, e.g., the unconscious victim.
No recommendations.