In stable patients with penetrating neck trauma, a reasonable approach is to perform a complete physical exam including an evaluation of the neck. Soft signs of penetrating neck trauma include: Hard signs of vascular or aerodigestive injury include: In unstable patients or those who have clear evidence (hard signs) of vascular or aerodigestive injuries, surgical exploration is indicated. More current technology using Multi-Detector Computed Tomographic Angiography (MDCTA) has allowed the safe and non-invasive evaluation of the critical neck structures and is now the gold standard for evaluating stable injuries in any zone that are causing symptoms. In what has been called the “selective approach,” zone II injuries underwent surgical exploration in the operating room, while patients with injuries in zone I and zone II underwent endoscopy and angiography. These zones have been used to help guide management, as injuries in zone II are most accessible to surgical intervention. (reproduced with permission from Color Atlas of Emergency Trauma, Second Edition) The superficial fascia lies anterior to the platysma, while the deep fascia lies posteriorly. Wounds that do not penetrate the platysma do not generally lead to significant morbidity or mortality. The platysma muscle stretches from the facial muscles to the thorax, and anatomically divides superficial from deep wounds. The neck can also be divided anatomically into facial planes. The spinal cord is the most significant structure in the posterior triangle of the neck.įor the management of penetrating trauma, the anatomy of the neck has historically been divided into three zones, which will be described in the section on penetrating injuries. The posterior triangle is bordered by the sternocleidomastoid anteriorly, the clavicle inferiorly, and the anterior border of the trapezius muscle posteriorly. The internal jugular vein, as well as the vagus and hypoglossal nerves, are contained within the anterior triangle. The common carotid artery bifurcates into the external and internal carotid arteries in the anterior triangle, which also contains the aerodigestive tract and cranial nerves VII, IX, X, XI, and XII. The anterior triangle of the neck is bordered superiorly by the inferior border of the mandible and posteriorly by the medial aspect of the sternocleidomastoid muscle. Areas of greatest concern include vascular injuries, neurologic injuries, and injuries to the aerodigestive tract. The neck contains a number of vital structures condensed into a relatively small area.
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