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PubMed2003

Experimental investigations of fractures of the upper thyroid horns.

Fractures of the upper thyroid horns are a frequent finding after a variety of neck injuries - resulting from a direct mechanical trauma, e.g. compression of the neck in manual strangulation or ligature strangulation, from blunt injuries (falls or blows against the neck), and sometimes from indirect trauma (whiplash-injuries). Although it is well known that thyroid horns can be broken with relatively little pressure, no quantitative data are available in the literature. In an experimental investigation, the isolated thyroid cartilage was prepared (divided into two parts, measured, X-rayed, photographed, embedded in paraplast) and clamped in a simple apparatus. Weight was applied on the upper thyroid horn (imitating pressure on the horns), beginning with 1 kg and gradually increased by increments of 250 g to a maximum of 8 kg, until an 'injury' occurred. In this study, 120 thyroid cartilages (77 men, 43 women, 16-95 years) were investigated. The location of the fractures was in nearly all cases the base of the horns. The mean weight resulting in an injury of the horn was 3 kg (men: 3.3 kg, women: 2.6 kg). The required weight was dependent on the degree of ossification. The highest rate of fractures was found in cases with incomplete ossification; in cases without ossification, specimens often remained macroscopically uninjured.

Adolescent↗
PubMed1992

[A case of pneumomediastinum caused by closed tracheal injury during the game of Kendo (Japanese fencing)].

A patient was injured accidentally on his neck during the game of Kendo (Japanese fencing). After his neck injury, he continued to play Kendo because there was no symptom at that time. Starting 10 minutes after the injury, swelling as well as pain on the neck and dyspnea developed gradually. After the admission to the emergency room, computed tomography revealed pneumomediastinum. Nasal endotracheal intubation was performed gently under fiberscopy. Dyspnea and pneumomediastinum improved gradually during the 6 days after the admission. A patient who has received a closed injury on his neck without immediate symptoms or signs must be observed closely because the absence of symptoms or signs does not guarantee the absence of the injury of the trachea.

Adolescent↗
PubMed1993

Physical examination and selective conservative management in patients with penetrating injuries of the neck.

This prospective study of 335 patients with penetrating injuries of the neck examined the decision whether to operate or observe according to a protocol based mainly on physical examination. Emergency angiography was performed in only three patients. Sixty-six patients (20 per cent) were subjected to emergency operation because of signs and symptoms suggestive of significant injury (60 patients) or because of positive investigations (six). The remaining 269 patients (80 per cent) were selected for non-operative management. Two of these patients (0.7 per cent) required elective operation during the initial hospital stay. No deaths occurred in patients treated conservatively. Some 192 (72 per cent) of observed patients were available for early follow-up and 111 (42 per cent) for late follow-up. No significant complications were found. Physical examination is a reliable method for detecting significant injuries following penetrating neck trauma. Emergency angiography is rarely necessary.

Adolescent↗
PubMed2003

Reliability of physical examination as a predictor of vascular injury after penetrating neck trauma.

The policy of routine angiography (ANG) for all penetrating neck wounds results in a high rate of negative studies. The medical records of all patients who presented to Wishard Memorial Hospital and Methodist Hospital of Indiana with penetrating injuries to the neck from January 1992 to April 2001 were reviewed. All patients who were hemodynamically stable underwent four-vessel ANG to evaluate for vascular injury irrespective of findings on physical examination (PE). A total of 216 patients sustained penetrating neck injuries. Patients were divided according to positive or negative PE findings and the results of ANG. Of the 63 patients with a positive PE, 40 (68%) also had a positive ANG finding. Of the 89 patients with negative PE, only 3 had a positive ANG and none of these injuries required operative repair. PE therefore had a 93 per cent sensitivity (SEN) and a 97 per cent negative predictive value (NPV) for predicting the results of ANG. The SEN and NPV of PE for detecting vascular injuries requiring operative repair were both 100 per cent. In this series, no patient with a negative PE had a vascular injury that required operative repair, irrespective of zone of injury. Routine ANG may therefore be unnecessary for patients with penetrating neck injuries and a negative PE.

Carotid Artery Injuries↗
PubMed2003

[Impalement injury of the neck].

In comparison to the United States or South Africa, penetrating injuries of the neck are rare in Europe. Most of these traumas are due to sharp perforation mechanisms. We report on a 43-year-old man who was admitted to the emergency room because of an impressive transcervical penetrating neck trauma inflicted by a chisel. He survived the trauma since the chisel missed all important structures of the neck. The diagnostic strategy to evaluate the dimension of the trauma was primarily based on endoscopic and surgical exploration.

Accidents, Occupational↗
PubMed1990

Long-term prognosis of soft-tissue injuries of the neck.

We reviewed 43 patients who had sustained soft-tissue injuries of the neck after a mean 10.8 years. Of these, only 12% had recovered completely. Residual symptoms were intrusive in 28% and severe in 12%. Pain in the neck and lower back was the commonest complaint and older patients had a worse prognosis. After two years, symptoms did not alter with further passage of time.

Adult↗
PubMed1988

Traumatic dissections of the extracranial internal carotid artery.

Traumatic dissections of the extracranial internal carotid artery (ICA) in 18 patients aged 19 to 55 years were studied. All had suffered blunt head or neck injury of marked or moderate severity; motor-vehicle accidents were the leading cause of the injury. Delayed focal cerebral ischemic symptoms were the most common presenting symptoms. Less commonly noted was focal unilateral headache associated with oculosympathetic paresis or bruit. Following a head injury, the abrupt onset of focal cerebral symptoms after a lucid interval should raise the suspicion of arterial injury, particularly when computerized tomography fails to show abnormalities that would explain the evolving neurological deficits on the basis of direct trauma to the brain. Unilateral headaches, oculosympathetic palsy, and bruits also help in establishing the diagnosis. Focal cerebral ischemic symptoms may develop months or years after the initial trauma. These delayed symptoms are caused by embolization from a thrombus within a residual dissecting aneurysm. Common angiographic findings, in decreasing order of frequency, are: aneurysm, stenosis of the lumen, occlusion, intimal flap, distal branch occlusion (embolization), and slow ICA-to-middle cerebral artery flow. Although two patients died as the result of massive cerebral infarction and edema and some were left with severe neurological deficits, most made a good recovery. Residual dissecting aneurysms and occlusion seem to occur more frequently with traumatic dissections than with spontaneous dissections of the extracranial ICA.

Adult↗
PubMed1997

Head positioning for high +Gz loads: an analysis of the techniques used by F/A-18 pilots.

A study was undertaken among Royal Australian Air Force fighter pilots to determine whether, as an occupational group, they had developed any particular protective head positioning strategies in order to minimize their risk of sustaining a +Gz-induced neck injury during air combat maneuvering. There were 42 F/A-18 Hornet pilots who responded to an anonymous questionnaire which asked about head positioning strategies. Of these, 29 pilots reported using a protective strategy. Several pilots reported using several different techniques. The most popular strategy reported was positioning the head prior to the application of +Gz (13 respondents). Eleven pilots reported using aircraft structures to wedge or brace their heads against. The results of this study show that fighter pilots who are regularly exposed to high +Gz forces develop an individualized approach to protecting their cervical spines from +Gz-induced injury.

Adult↗
PubMed1996

Frontoethmoidal fractures as a result of war injuries.

Ninety frontoethmoidal fractures, as a result of war injuries from 1991 to 1994, produced 0.7% of all war injuries (i.e., 9% of head and neck injuries treated in the Military Medical Academy, Belgrade). These injuries were mainly part of complex endocranial, orbital, and zygomaticomaxillary injuries, and were rarely isolated. The central part of these injuries were in the ethmoidal region, which was isolatedly injured in 23.3% of the cases. There was 53.3% injuries with small fragments of explosive devices inside the wound, and 16.7% of through-and-through wounds were caused by sniper bullets. The priority over all definitive operative procedures belonged to osteoplasties whenever possible, because the primary goal was protection of life. About 3.3% of the patients died because of severe hemorrhagic shock and endocranial injury. There was only one case of recurrent meningitis. Most of the patients had multiple injuries and were mutually operated on by two different surgical teams.

Adult↗
PubMed1993

Psychiatric consequences of road traffic accidents.

OBJECTIVE: To determine the psychiatric consequences of being a road traffic accident victim. DESIGN: Follow up study of road accident victims for up to one year. SETTING: Emergency department of the John Radcliffe Hospital, Oxford. SUBJECTS: 188 consecutive road accident victims aged 18-70 with multiple injuries (motorcycle or car) or whiplash neck injury, who had not been unconscious for more than 15 minutes, and who lived in the catchment area. MAIN OUTCOME MEASURES: Present state examination "caseness"; post-traumatic stress disorder and travel anxiety; effects on driving and on being a passenger. RESULTS: Acute, moderately severe emotional distress was common. Almost one fifth of subjects, however, suffered from an acute stress syndrome characterised by mood disturbance and horrific memories of the accident. Anxiety and depression usually improved over the 12 months, though one tenth of patients had mood disorders at one year. In addition, specific post-traumatic symptoms were common. Post-traumatic stress disorder occurred during follow up in one tenth of patients, and phobic travel anxiety as a driver or passenger was more common and frequently disabling. Emotional disorder was associated with having pre-accident psychological or social problems and, in patients with multiple injuries, continuing medical complications. Post-traumatic syndromes were not associated with a neurotic predisposition but were strongly associated with horrific memories of the accident. They did not occur in subjects who had been briefly unconscious and were amnesic for the accident. Mental state at three months was highly predictive of mental state at one year. CONCLUSIONS: Psychiatric symptoms and disorder are frequent after major and less severe road accident injury. Post-traumatic symptoms are common and disabling. Early information and advice might reduce psychological distress and travel anxiety and contribute to road safety and assessing "nervous shock."

Accidents, Traffic↗
PubMed2005

Is field hypotension a reliable indicator of significant injury in trauma patients who are normotensive on arrival to the emergency department?

There is a subset of trauma patients who are hypotensive in the field but normotensive on arrival to the emergency department (ED). Our objective was to evaluate the presence, type, and severity of injuries in these patients. Data were retrospectively reviewed from patients treated at a level 1 trauma center over 1 year. Hypotension was defined as systolic blood pressure (SBP) less than 90 mm Hg. Forty-seven patients were included. The mechanism of injury was blunt in 37 patients and penetrating in 10. The average field SBP was 76 +/- 11 mm Hg. The average SBP on arrival to the ED was 120 +/- 19 mm Hg. The average injury severity score (ISS) was 16.3 +/- 10.3 (range, 1-43). Twenty-four patients (51%) had significant injury (ISS > or = 16). Nine patients (19%) had critical injury (ISS > or = 25). Twenty-six patients (55%) required surgery, and 43 (91%) required ICU admission. Common injury sites included the head and neck (57%), thorax (44%), pelvis and extremities (40%), and abdomen (34%). Overall mortality was 10 per cent (n = 5). All patients that died had significant head and neck injuries (AIS > or = 3). Field hypotension was a significant marker for potential serious internal injury requiring prompt diagnostic workup.

Adolescent↗
PubMed2003

Biomechanical injury evaluation of laminated side door windows and sunroof during rollover accidents.

Significantly more fatalities and serious injuries occur due to ejection in roll over accidents. The present study was conducted to determine the occupant retention and head-neck injury potential aspects of laminated glass in side door windows and sunroofs during roll over accidents. The test protocol for this study was based on National Highway Traffic Safety Administration (NHTSA) studies for advanced glazing. The impact study of 18 kg with head-neck form was conducted on laminated glass of side doors and sunroofs from production vehicles. The drop speed was varied from 11 to 16 kph. The Hybrid III 50% male dummy head-neck form was impacted on the approximately center of the glass portion of the windows. The head injury criteria, head resultant acceleration, and neck loads and moments were quantified. A series of drop tests were conducted on roll down side windows with laminated glass. The head-neck biomechanical parameters were well below the critical value injury tolerance limits. Results indicated that the glass contained the dummy assembly and the head-neck biomechanical parameters were below the critical value injury tolerance limits in simulated rollover accidents. The present study demonstrates that head-neck injury is unlikely due to laminated glass side windows and sunroof laminated glass used in production vehicles during rollover accidents and that the dummy is contained by the laminated glazing.

Acceleration↗
PubMed2004

Head positioning and neck muscle activation during air combat.

INTRODUCTION: Specific mechanisms leading to acute neck injury in flight as a result of +Gz exposure remain unclear. In this study, head positions adopted by aircrew in air combat have been quantified, and the associated levels of cervical muscle activation have been determined. METHOD: Six fast jet aircrew subjects were instrumented with surface electromyography (EMG) electrodes, and activation potentials from neck erector spinae (ES) and sternocleidomastoid (SC) muscles were logged on a data recorder. EMG signal was normalized to preflight maximum voluntary contraction (MVC). All subjects flew a one-on-one air combat sortie in a Hawk T1 aircraft comprising at least four air combat engagements. In-cockpit video and +Gz acceleration were recorded. Time-synchronized analysis of video, EMG, and acceleration were conducted for head position and normalized muscle activation (%MVC). RESULTS: During air combat, the head was away from neutral for 68% of the time, predominantly in extension, or rotation plus extension. During neck extension under G, 40-80% MVC occurred in the ES: this was reduced by half when the canopy was used as a support. Similar activation occurred in the SC in neck extension plus rotation. The ES was activated at over 40% MVC for 25% of the engagement duration. Postsortie, 35% reduction in neck muscle strength occurred. CONCLUSIONS: Extreme neck extension +/- rotation is very common in air combat and is associated with high levels of muscle activation and fatigue. This information can be used to help devise targeted neck conditioning and positioning strategies in order to reduce injury risk.

Adult↗
PubMed1991

Head and neck trauma in sporting activities. Review of 208 cases.

Head and neck injuries due to sports and games represent 22.7% of all injuries admitted to the E.N.T. Department of the University of Perugia between 1980 and 1988. Epidemiological and causative factors of these injuries are examined by the authors, together with their treatment: the majority of accidents occurred during soccer games as a consequence of collisions between players. In these cases the most frequently recorded lesion was a nasal fracture. Other sporting activities were responsible for more serious injuries to the maxillo-facial bony, cartilaginous and soft tissue structures. Good results were achieved both on the anatomical and functional planes, except for a few cases of facial disruption and multiple mandibular fractures. The authors stress the importance of preventive measures, consisting of periodical medical check-ups, an adequate level of umpiring and the wearing of protective equipment, such as helmets and masks.

Adult↗
PubMed1989

Suicide by band saw.

Suicidal injuries caused by power tools have rarely been reported in the literature. The case of a 37-year-old white male schizophrenic patient who sustained a fatal self-inflicted neck injury from a band saw, while engaging in occupational therapy, is presented. Unusual features of this type of injury as noted at postmortem examination were the extent of the wound, the absence of hesitation injuries, and the presence of grease wipe, bone dust, and sawdust within the wound.

Adult↗
PubMed2003

Acceleration effects on neck muscle strength: pilots vs. non-pilots.

BACKGROUND: Conditioning of neck muscles, if any, due to repeated exposures to +Gz forces has received little research attention. OBJECTIVE: This study was conducted to evaluate and compare the neck muscle strength of test volunteers representative of the general populations of fighter aircraft pilots and non-pilots. METHODS: The tests were performed using a special attachment device on a computerized dynamometer. Ten pilots and ten non-pilots volunteered as test subjects. Each individual's maximal isometric neck muscle strength was evaluated in the extension, flexion, and left and right lateral bending directions in a single day. Peak values from the measurements were used for data analysis. Overall neck strength was calculated as the mean values for the four directions in each group. RESULTS: The overall muscular strength of the necks of pilots did not differ significantly from that of non-pilots, nor did exposure to +Gz forces lead to specific changes in isometric muscle strength across any of the four principal directions. Neck muscle strength in the four measured directions pooled across the two subgroups were statistically significant. The widespread practice of adopting protective head-positioning strategies to minimize neck strains, coupled with results from this research study, suggest that the neck muscles are subjected to reduced in-flight strengthening workouts during exposures to +Gz forces. CONCLUSIONS: To maximize in-flight performance and minimize +Gz-induced neck injuries, fighter pilots should be encouraged to perform on-land neck muscle strengthening exercise and in-flight head-positioning techniques. More research is needed to fine-tune this countermeasure strategy against cervical spine injury.

Adult↗
PubMed1995

Thoracic duct injury in penetrating neck trauma.

Thoracic duct laceration from penetrating neck trauma is a rare injury associated with significant morbidity. Seventy-one cases published in the English literature in the last 50 years, along with one new case, were reviewed in an attempt to characterize the clinical profile, treatment, and outcome.

Adult↗
PubMed2005

[Injuries of the head and neck in suicidal intention].

BACKGROUND: Injuries of the head and neck with suicidal intention might create serious situations that require rapid and interdisciplinary treatment. METHODS AND PATIENTS: Twenty-seven patients with suicidal head and neck injuries were treated at the Department of oto-rhino-laryngology, head and neck surgery, University of Wurzburg/Germany, between 1991 and 2002. The medical histories were analyzed retrospectively. RESULTS: Twenty-three of them were male, 4 female. Mean age at time of attempted suicidal was 48 years (18 - 90). One patient was already treated for a psychiatric disorder. None of the patients had a suicidal attempt in the history. Nine patients suffered from a pharynx or larynx trauma after strangulation. Four out of seven patients with cutting or stabbing injuries showed a perforation of the upper airways. Nine patients had gunshot traumas, one of them with perforation of the pharynx. Thirteen patients underwent immediate endoscopy under general anaesthesia followed by a neck exploration in 3 patients. Six patients received a temporary tracheotomy. All patients were considered suicidal for the duration of stay in the ENT-department resulting in a permanent supervision. All patients were transferred to a psychiatric unit as soon as possible for further treatment. A statistically significant accumulation was observed during the last third of a year. Over the period of 11 years, suicidal injuries of the head and neck tend to occur more frequently. CONCLUSIONS: The presented study emphasizes the need of immediate surgical and intensive care treatment of patients with head and neck injuries due to suicide attempts as well as an adequate psychiatric supervision during as well as after the surgical treatment.

Adolescent↗