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PubMed2000

Penetrating neck injury: case report and evaluation of management.

Greater urban violence has resulted in an increased incidence of penetrating neck trauma. Penetrating neck wounds can present difficult diagnostic and therapeutic dilemmas. The evaluation and management of such injuries, however, remains controversial. There is no universally accepted specific approach to the management of patients with penetrating neck injuries, with some surgeons advocating mandatory neck exploration whilst others believe in selective surgical intervention. We believe that an equal willingness for both conservative and surgical intervention as dictated by serial bedside evaluation with adequate radiological and endoscopic support can provide the clinician a safe and effective means of managing a potentially complex and lethal problem.

Adult↗
PubMed2003

Analysis of neck injuries in hanging.

Retrospective study of suicidal hangings was made on 175 cases (133 male victims, 42 female victims) for a 5-year period. The mean age was 47.33 +/- 17.51 years. The sample was divided in 4 groups according to the position of the ligature knot (anterior, right, left, and posterior hanging). The authors analyzed all visible injuries of soft tissues and bones and cartilage of the neck, and in 150 cases (85.7%), we established that there was at least one injury of these structures (hematoma or fracture for example). The most frequent injury was to sternocleidomastoid muscles. Fracture of throat skeleton was detected in 119 cases (68%). The proportion of fractures increases with age of the deceased. There was no clear correlation between frequency of neck injuries and type of hanging.

Adolescent↗
PubMed1962

Neck injuries.

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Cervical Vertebrae↗
PubMed2006

Urethral and bladder neck injury associated with pelvic fracture in 25 female patients.

PURPOSE: We describe the presentation, diagnostic evaluation, management and outcome of female urethral trauma. MATERIALS AND METHODS: All female patients treated at Harborview Medical Center between 1985 and 2001 with urethral injury were identified by International Classification of Diseases 9th revision code. Approval of the Human Subject Division was obtained and patient charts were reviewed. The Urogenital Distress Inventory Short Form, the Incontinence Impact Questionnaire Short Form and the Female Sexual Function Index were sent to the patients. RESULTS: A total of 25 patients (13 adults, 12 children) with a mean age of 22 years (range 4 to 67) met inclusion criteria. All had pelvic fracture related to blunt trauma. They represented 6% of all female patients treated in the same review period with pelvic fracture. Blood was seen at the introitus in 15 patients and 19 had gross hematuria. Of the injuries 9 were avulsions, 15 were longitudinal lacerations and 1 was not further specified. Primary repair was performed in 21 patients and 4 were treated nonoperatively. There were 5 patients who required secondary procedures including fistula repair in 4 and continent urinary diversion in 1. At a mean followup of 7.3 years (range 1.6 to 14.4) 9 of 21 patients (43%) had moderate or severe lower urinary tract symptoms and 8 of 13 (38%) had sexual dysfunction (FSFI score less than 26.55). CONCLUSIONS: Female urethral and bladder neck injury occurs with pelvic fracture, presents with gross hematuria and/or blood at the introitus, and requires operative repair for avulsions and longitudinal lacerations. These patients are at risk for significant sexual and lower urinary tract dysfunction.

Adolescent↗
PubMed1984

Selective management of penetrating neck injuries. A prospective study.

We assessed the feasibility of a selective policy for operative exploration of penetrating neck wounds. Patients with bleeding, hematomas, crepitations, dysphagia, dysphonia, or impaired mental status rendering their conditions nonevaluative had prompt explorations. All other patients were observed in the hospital. Of the 77 patients in this study, 48 (62%) underwent neck exploration based on the preceding criteria; (85%) had major injuries. Of the 29 patients observed according to protocol, none required subsequent exploration for a missed lesion. Ancillary diagnostic procedures in the observed patients consisted of arteriography in four, esophageal contrast studies in five, esophagoscopy in two, and laryngoscopy in one. The average hospital stay for observation was 1.8 days. Our experience confirms the safety and cost-effectiveness of selective exploration for penetrating neck injuries. Moreover, observation does not mandate extensive ancillary testing for level II and III injuries.

Adolescent↗
PubMed1964

THE CONSERVATIVE MANAGEMENT OF NECK INJURIES.

Previously a list of treatments which might be avoided in the care of simple neck sprains was published. The present discussion is with regard to treatment which may be used safely. The original discussion was to the effect that treatment should be avoided which aggravates the patient's pain. Now suggestions are made for treatment which should not produce iatrogenic trauma. This treatment has the advantage of reducing the financial cost to the injured person plus the medical advantage of shortening the period of treatment, reducing cost and disability.

Exercise Therapy↗
PubMed1972

A neck injury.

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Child, Preschool↗
PubMed1975

[Neck injuries].

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Cervical Vertebrae↗
PubMed2001

Neck injuries as a reconstructive parameter in car-to-pedestrian accidents.

The study has assessed the usefulness of injuries to the ligamentous, muscular and vascular neck structures for deducing about the presumable location of a pedestrian in relation to a motor vehicle at the moment of collision. The localisation of haemorrhagic suffusions in the lower insertions of the scalene (mainly) and sternocleidomastoid muscles has shown a correlation with the direction of the inertia force. No correlation has been observed between the direction of impact and damages to the cervical vascular bundles and the localisation of haemorrhagic suffusions in the upper insertions of the nape muscles. In some cases, injuries to the ligaments of the cervical vertebrae made up the complex characteristic of the direction of acting forces. The injuries of soft tissues and ligaments can, thus, facilitate the deductions about the direction of impact. However, the type of a car involved in the accident and the possibility that these injuries resulted from direct head or neck trauma should be considered.

Accidents, Traffic↗
PubMed1991

Catastrophic Head and Neck Injuries.

Although all athletic injuries require careful attention, the evaluation and management of injuries to the head and neck should proceed with particular consideration. The actual or potential involvement of the nervous system creates a high-risk situation in which the margin for error is low. This chapter presents guidelines for classification, evaluation, and emergency management of catastrophic injuries that occur to the head and neck as a result of participation in competitive and recreational activities.

Journal Article↗