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Unusual perforating foreign body in the neck.

Penetrating injury in the neck is not an uncommon condition, but a perforating foreign body like bamboo in the neck is uncommon. A 36 years old young man was admitted in Otolaryngology and Head Neck surgery department, Mymensingh Medical College hospital, with a history of accidental perforating injury in the neck with a bamboo, while driving a vehicle (tempo). Clinical examination revealed a bamboo measuring 4.6 X 0.09 ft. perforated in his neck from left to right. Surprisingly great vessels and air way spared. Due to difficult intubation, elective tracheostomy was done. Neck was explored and foreign body removed under general anesthesia. Haemostasis ensured and wound closed in layers after putting drain tubes. Recovery was uneventful and was discharged after three weeks.

Adult↗

Penetrating neck trauma: lack of universal reporting guidelines.

Penetrating neck injuries constitute a heterogeneous group. Two different classifications of zones of the neck exist in trauma literature. Injuries crossing the midline are not accurately reported. Records of 50 patients with stab wounds (30), gunshot wounds (GSWs; 17), and shotgun wounds (SGWs; 3) were reviewed. Injuries involved zone I in 8 patients, zone II in 37 patients, zone III in 8 patients, posterior triangle in 6 patients, and multiple zones in 5 patients. All 11 patients with transcervical GSWs and SGWs sustained vascular or aerodigestive injuries and had longer hospital stays (14.0 +/- 2.6 days) compared with patients with other GSWs (6.6 +/- 2.0 days) and stab wounds (3.6 +/- 0.5 days). We emphasize the lethal potential of transcervical GSWs and SGWs. We suggest that these particular injuries be reported separately. We recommend the universal adoption of one system of classification of neck zones.

Adolescent↗

Use of a gum elastic bougie (GEB) in a zone II penetrating neck trauma: a case report.

A 54-year-old man presented with a deep zone II neck injury accompanied by profuse bleeding secondary to attempting suicide by slashing his anterior neck with a knife. Blind passage of the endotracheal tube (ETT) into the glottis through the open anterior neck was unsuccessful. In a second attempt a gum elastic bougie (GEB) was inserted directly through the vocal cord, and "tracheal clicking" and a "hold up" were appreciated. The ETT was then easily fed over the GEB and was successfully passed into the trachea. The patient underwent operative repair and tracheostomy, and he left the hospital 2 days later with his baseline mental status. The use and the benefits of the GEB are reviewed.

Equipment Design↗

Differences in trauma care among pediatric and nonpediatric trauma centers.

To characterize pediatric trauma care, state trauma registry data from all designated trauma centers in Pennsylvania were divided into three categories, that from: (1) pediatric centers, (2) urban nonpediatric centers, (3) and rural nonpediatric centers. From October 1, 1986 through September 30, 1989 (3 years), 4,615 patients less than 15 years old were admitted to 28 trauma centers in Pennsylvania. Nonpediatric centers cared for the majority of children (2,734, 59.2%), but the average number of children treated per nonpediatric institution (105.1 per year) was far fewer than the average treated in the pediatric centers (940.5). Pediatric trauma centers in the state treated a younger population (6.4 +/- 4.2 years, mean +/- SD) compared with urban and rural nonpediatric centers (8.4 +/- 4.2 and 8.1 +/- 4.3 years, respectively; P less than .05). Pediatric centers received proportionately more children by transfer (56.2%), victims of falls (34.6%), pedestrian injuries (16.8%), and head and neck injuries (41.8%, all P less than .05). Nonpediatric centers received children directly from the scene of injury more frequently than transferred from other hospitals. The male:female sex ratio in urban nonpediatric centers was significantly higher (70.1%, P less than .05) than in the other two groups. Rural nonpediatric centers cared for a higher proportion of motor vehicle passengers (28.5%) and patients classified as "other" in the state registry, a category to which bicycle injuries are assigned (28.2%, P less than .05). Mortality was highest in rural nonpediatric centers (6.2%). The death rate in pediatric centers and urban nonpediatric centers were similar (4.1%) and significantly lower (P less than .05).(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗

The contribution of brain injury to the overall injury severity of brain-injured patients.

Several recent population-based studies of the incidence of head injury have identified cases by screening hospitalized patients. This method assumes a close relationship between severity of head injury and overall injury severity, since it is the latter that determines hospital admission. Thus, a patient whose overall injury severity is high will be admitted to the hospital regardless of the degree of his head injury. Similarly, since a patient's outcome status after treatment depends on his response to all his injuries, studies of the prognosis of various types of head injury also assume a close relationship between head injury severity and overall injury severity. The present study examines the relationship between brain injury severity and overall injury severity in a series of hospitalized head-injured patients with evidence of actual or probable brain trauma. Among these patients, brain injury severity was closely related to overall injury severity. Head injury severity and head and neck injury severity were also closely related to overall injury severity. For all other body regions, injury severity was not closely related to overall injury severity in this group of patients.

Adolescent↗

Mechanisms of injury in competitive off-road bicycling.

OBJECTIVE: To describe the mechanisms of injury from crashes during competitive off-road bicycling (mountain biking) and to examine the type, location, and severity of the resulting injuries. METHODS: We examined and interviewed all bicyclists injured while competing at 7 off-road bicycling events. Information regarding the direction of fall and the presence of a collision or mechanical failure was obtained, and the injury patterns were compared. RESULTS: There were 97 injured riders, with a mean age of 28.3 years. Most victims were male (74%), and all cyclists wore helmets. Most injuries were minor and involved the extremities (70.5%). Injuries sustained from falling forward over the handlebars occurred more often than from falling to the side (65% vs 25%), tended to lead to injuries that were more severe (mean injury severity score [ISS] = 3.4 vs 1.7, P < .05), and produced more head and neck injuries (56% vs 8%, P < .05). Falls to the side generally led to a lower extremity injury (88% vs 57%, P < .05). Riders who were involved in collisions had injuries that were similar in severity and location to those of riders who had no collision. CONCLUSIONS: These findings suggest that off-road bicyclists whose mechanism of injury involves falling forward over the handlebars are at risk for more severe injury, especially to the head and neck.

Adolescent↗

A comparison of chiropractic, medical and osteopathic care for work-related sprains and strains.

The cost of care and the number of days lost because of work injury were analyzed from information gathered in a postal card survey sent to all Iowa back or neck injury claimants (sprain/strain) on record for 1984. Descriptive findings for the flow of care of the respondents were evaluated and a comparison made of the benefits and costs of care received by patients treated by chiropractic doctors (DCs), medical doctors (MDs) or osteopathic doctors (DOs). The analysis focused on those workers who lost enough time from work to qualify for compensation (4 days or more), whose cases were closed and who received all their care from one health professional. For those who received care from DCs (n = 266), the mean number of compensated days lost from work was at least 2.3 days less than for those who were treated by MDs (n = 494; p less than 0.025) and at least 3.8 days less than for those who were treated by DOs (n = 102; p less than 0.025). Consequently, much less money in employment compensation was paid, on the average, to those who saw DCs. Findings on provider care costs are less clear-cut because care-cost data on only a portion of the cases was recorded on the State records used. For the data available, the median provider cost was highest for patients who saw DCs, but the mean was highest for those who saw MDs. The study showed that 38% of claimants did change doctors. When change of provider occurred, days lost from work and cost of care varied widely across the care options, but generally, fewer workdays were lost and lower amounts of disability compensation and provider cost paid when chiropractic was included in the care pattern.

Absenteeism↗

Penetrating injuries of the neck: criteria for exploration.

One hundred thirty-six patients with penetrating injuries of the neck over a 4-year period were studied prospectively. Seventy-two patients (52.9%) had no major physical signs on admission, 56 were observed without complications, and 16 had a negative exploration. Injuries below the level of the cricoid cartilage were associated with a very high mortality (12.12%). We recommend a policy of selective conservatism in the management of penetrating neck injuries.

Brachial Plexus↗

Stairway-related injuries in children.

OBJECTIVE: To identify the pattern and severity of injury associated with stairway-related falls in children. METHODS: During a 2-year period, all children less than 5 years of age presenting to the University of Virginia Pediatric Emergency Department with a stairway-related injury were prospectively studied. At the time of the emergency department visit, demographic and epidemiologic information was obtained. Injuries were assigned E codes and N codes. A Modified Injury Severity Scale (MISS) score was calculated for each child. Excluded from the study were children with suspected intentional trauma and children with walker-related stairway injuries. RESULTS: Sixty-nine children were enrolled in the study. The median age was 2 years. Head and neck injuries occurred in 90% of the patients, extremity injuries in 6%, and truncal injuries in 4%. Injury to more than one body region did not occur. The majority of injuries were minor. Ninety-six percent had a total MISS score < or = 2. Fifteen patients (22%) suffered significant injuries, including concussion in 11 (16%), skull fracture in 5 (7%), cerebral contusion in 2 (3%), subdural hematoma in 1 (1%), and a C-2 fracture in 1 (1%). CONCLUSIONS: The majority of stairway-related injuries are minor. Injuries to the head and neck region predominate. Injuries to multiple body regions are rare. However, significant stairway-related injuries may be more common than previously reported.

Accidental Falls↗

Colour-flow ultrasound in the detection of penetrating vascular injuries of the neck.

PURPOSE: To determine the sensitivity of colour-flow ultrasound in the detection of penetrating vascular injuries of the neck when compared with conventional angiography. METHOD: We prospectively imaged the neck arteries of all patients with suspected vascular injuries who were referred for angiography by the vascular surgeon over a 6-month period. All sonograms were performed by the same radiologist before angiography using a 7.5 or 10 MHz transducer on the same scanner. Data recorded were the presence or absence of vascular injury, the site of injury, and the type (intimal, dissection, false aneurysm or fistula). Angiography was performed immediately afterwards by a different radiologist. Results were correlated with the angiogram and operative findings. RESULTS: 25 patients were studied. 15 patients had normal ultrasound studies and angiograms. Ultrasound studies were positive in 10 patients (40%), with false aneurysms and arteriovenous fistulas detected in 8 patients; these were confirmed on angiography and at operation. There were intimal injuries in 2 patients (4%) that were undetected on angiography but confirmed at surgery. There were no false-positive or false-negative ultrasound studies. CONCLUSION: Colour-flow ultrasound is sensitive in detecting vascular injuries and is suitable as a screening investigation in patients with penetrating neck injuries.

Adult↗

Penetrating injuries to the neck. Pitfalls in management.

One hundred patients with penetrating injuries to the neck were evaluated. The safest, most expeditious method of managing a penetrating injury to the neck is still prompt surgical exploration. Patients with positive physical examination have definite indications for surgerymin our series, 93 per cent of these patients had significant injuries. Patients with negative physical examinations are still optimally treated with neck explorations. The mortality of this series was 2 per cent. In specific situations, nonoperative management of penetrating injuries to the neck may be useful. This modality, however; should not be construed as "conservative" management. Specific pitfalls noted include inadequate neck exploration, failure to completely examine the patient, and being unprepared for exploration outside the neck.

Accidents, Traffic↗

The rate of recovery following whiplash injury.

Fifty consecutive patients with soft-tissue neck injuries following rear end collisions were studied prospectively to assess their rate of recovery. Patients were seen within 5 days of the accident, after 3 months, 1 year and 2 years, and their symptoms were classified into one of four groups (A, asymptomatic; B, nuisance; C, intrusive; D, disabling). Fourteen of 15 patients (93%) who were asymptomatic after 3 months remained symptom-free after 2 years. Of 35 patients with symptoms after 3 months, 30 (86%) remained symptomatic after 2 years. After 1 year, 26 (52%) stated that they had recovered completely, but after 2 years this had fallen to 19 (38%). Nine of the 15 patients who had improved between 3 months and 1 year deteriorated to their previous status, or worse, between 1 and 2 years. In asymptomatic cases, a prognosis that is 93% accurate after 2 years can be given after 3 months, and 86% of patients who are symptomatic after 3 months will remain so after 2 years. However, the severity of their symptoms will change during this period and will be at the same degree of severity in less than 50%.

Adolescent↗

[Eyelid and facial injuries due to dog bites].

BACKGROUND: Head und neck injuries of children are mistly due to dog bite. PATIENTS AND METHODS: During the 10-year interval from 1990 to 2000 sixteen patients suffering from dog bite injuries were seen in our department. Age, gender, pattern of ocular and periocular wounds, surgical management and long-term damage were analyzed. RESULTS: Medial lower eyelid injuries with lacrimal duct involvement were most common. Ten victims were younger than four years. 87% of the dogs belonged to the family and friends of the patients. Two localized infections and no systemic infection were seen. CONCLUSION: Primate microsurgical wound repair leads to a satisfying functional, morphological, and esthetic long-term result.

Age Distribution↗

Acute cervical hyperextension-hyperflexion injury may precipitate and/or exacerbate symptomatic multiple sclerosis.

We report here 39 cases in which definite multiple sclerosis (MS) was precipitated or exacerbated by specific hyperextension-hyperflexion cervical cord trauma. The worsening or onset of the symptomatic disease bore a striking temporal relationship to the focal injury. Our data suggests that central nervous system (CNS)-specific acute physical trauma such as cervical cord hyperextension-hyperflexion injury may aggravate latent clinical symptoms in MS. The deterioration of MS bore no direct relationship with the severity of neck injury. Possible pathogenic mechanisms of focal CNS-specific trauma aggravating the course of asymptomatic or benign MS are discussed. This may have implications in improving our understanding of the factors that may modify the clinical course of MS.

Adult↗

Neck and low back injuries in wrestling.

Drs. Wroble and Albright review the neck and low back injuries of the University of Iowa wrestling teams over the last 8 years with respect to diagnosis, mechanism of injury, time lost from wrestling, and recurrence. They describe examination of the low back and treatment of low back injuries. Examination of the neck is reviewed in detail and common neck injuries are discussed. Emergency management of acute neck injuries is outlined. Various aspects of prevention of neck injuries are presented.

Adult↗

Some observations on whiplash injuries.

Motor vehicle accidents with a whiplash mechanism of injury are one of the most common causes of neck injuries, with an incidence of perhaps 1 million per year in the United States. Proper adjustment of head restraints can reduce the incidence of neck pain in rear-end collisions by 24%. Persistent neck pain is more common in women by a ratio of 70:30. Whiplash injuries usually result in neck pain owing to myofascial trauma, which has been documented in both animal and human studies. Headaches, reported in 82% of patients acutely, are usually of the muscle contraction type, often associated with greater occipital neuralgia and less often temporomandibular joint syndrome. Occasionally migraine headaches can be precipitated. Dizziness often occurs and can result from vestibular, central, and cervical injury. More than one third of patients acutely complain of paresthesias, which frequently are caused by trigger points and thoracic outlet syndrome and less commonly by cervical radiculopathy. Some studies have indicated that a postconcussion syndrome can develop from a whiplash injury. Interscapular and low back pain are other frequent complaints. Although most patients recover within 3 months after the accident, persistent neck pain and headaches after 2 years are reported by more than 30% and 10% of patients. Risk factors for a less favorable recovery include older age, the presence of interscapular or upper back pain, occipital headache, multiple symptoms or paresthesias at presentation, reduced range of movement of the cervical spine, the presence of an objective neurologic deficit, preexisting degenerative osteoarthritic changes; and the upper middle occupational category. There is only a minimal association of a poor prognosis with the speed or severity of the collision and the extent of vehicle damage. Whiplash injuries result in long-term disability with upward of 6% of patients not returning to work after 1 year. Although litigation is very common and always raises questions of secondary gain in patients with persistent symptoms, most patients are not cured by a verdict. Acute treatment of neck pain consists of ice for 24 hours followed by heat applications, pain pills, NSAIDs, and muscle relaxants. Trigger point injections can be beneficial in both the acute and the persistent phases. Use of cervical collars should probably be kept to a minimum during the first 2 to 3 weeks after the injury and then avoided. Early passive mobilization and range of motion exercises may accelerate recovery. Physical therapy and transcutaneous nerve stimulators may be helpful in reducing pain and improving movement.(ABSTRACT TRUNCATED AT 400 WORDS)

Diagnosis, Differential↗