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PubMed2007

Pseudoaneurysm of the common carotid artery due to ongoing trauma from the hyoid bone.

We report a left common carotid artery pseudoaneurysm in a 47-year-old bricklayer with no prior surgical procedures or acute neck injury. At operation, the pseudoaneurysm was found to be related to ongoing injury to the carotid artery from the tip of the hyoid bone. The most likely explanation for this was that the patient's job required that he carry cement panniers weighing about 15 kg on his left shoulder and that these panniers repeatedly compressed the left side of his neck, thus forcing the carotid against the hyoid.

Aneurysm, False↗
PubMedDate not supplied

Cineradiographic study of football helmets and the cervical spine.

A total of 16 men (4 professional football players, 5 high school athletes, and 7 hospital personnel) was studied by cineradiography to evaluate the possible roles of the posterior rim of the football helmet in causing neck injuries. The men ranged from tall elongated neck individuals to short chunky neck individuals. Moving picture (16-mm) films were produced from a series of lateral view cineradiograms that were taken to document the path and position of the posterior rim of the helmet relative to the spinal column as the subject moved his head from the fully flexed to the fully extended positions under several loading conditions. Five different helmets, all from different companies, were used in the studies. No contact existed at any time between the posterior rim of any of the five helmets worn and the fourth cervical vertebral spinous process; in fact, it did not come close to the spinous process of vertebrae C1 through C6. The notion of the posterior rim of the helmet being capable of striking the cervical spine about the C4 to C5 level is without foundation.

Athletic Injuries↗
PubMed1995

The perceived relationship between neck symptoms and precedent injury.

A questionnaire survey of 328 hospital employees was used to establish the general prevalence of neck symptoms related to everyday activities in a representative population of working society. The response rate was 92 per cent. Of the study population of 302, 54 had suffered neck injury, and of this group, 43 (80 per cent) had some neck discomfort during or after performing normal everyday tasks. Of the symptomatic cases, only seven (16 per cent) admitted that they had suffered from some neck symptoms before the injury, whilst 36 (84 per cent) attributed all of their neck symptoms to the injury sustained. Of the total population, 248 had not suffered a neck injury and of this group 84 (34 per cent) suffered some neck discomfort during or after performing normal everyday tasks. The chi 2 test was used to test the null hypothesis that the sub-group attributing their symptoms to injury, in whom only 16 per cent acknowledged pre-existent neck symptoms, was derived from the same population as the group who had not suffered any definite neck injury, and yet were still troubled with some neck symptoms in 34 per cent of cases. This hypothesis was rejected (P < 0.01), indicating that there was a significant difference between these two groups. We conclude that some individuals who suffer a neck injury do not recall that they suffered some minor neck symptoms before injury. The statistical analysis and alternative possible explanations are discussed. Our conclusions may be of medico-legal importance in cases where compensation is being sought.

Accidents, Occupational↗
PubMed1988

'Whiplash injuries' of the neck: a retrospective study.

This is a retrospective study of 102 patients with whiplash injuries of the neck followed up at approximately 2 years. The results show that 67 patients were asymptomatic by this time and the remaining 35 patients still exhibited symptoms. Prognostic indicators were found to be age, occipital headaches, referred symptoms, interscapular pain, abnormal neurological signs, positive radiological findings and osteoarthritic changes of the cervical spine. Symptoms that persisted for more than 2 months indicated prolonged disability.

Accidents, Traffic↗
PubMed1975

A case of severely cut throat.

A 42-year-old man was admitted to hospital with serious neck injuries and partial exposure of the oropharynx. He was sedated and the larynx and trachea were anaesthetized with lignocaine to allow endotracheal intubation. In the course of these procedures, previously unsuspected injuries of the tongue and soft palate were discovered. The contraindications to endotracheal intubation under general anaesthesia in cases of this type are discussed.

Accidents, Occupational↗
PubMed2002

Upper root brachial plexus trauma; patient selection and reconstruction.

Injury to the brachial plexus is increasingly common and the initial management of these patients is usually focused on associated life threatening injuries. Appreciation of the management of the brachial plexus injury can greatly assist with subsequent reconstruction and thus we review our experience in this field. A total of nine patients who underwent upper root brachial plexus reconstruction over the period 1980-1998 were reviewed. Causes of injury included road traffic accidents (n=6), open injuries (n=2) and the remaining case was iatrogenic. All patients had cabled grafting of the plexus while one patient had neurotization of the plexus in addition to grafting. Sixty six percent (n=6/9) of patients had a good outcome with return of elbow flexion. Patients with an open injury to the plexus had a better prognosis than those who had a closed injury. Polytrauma patients and those with penetrating neck injuries should be assessed to exclude brachial plexus injury. Baseline assessment and early involvement of surgeons with an interest in this area will help select those patients who will benefit from brachial plexus reconstruction.

Accidents, Traffic↗
PubMed2004

The increasing incidence of severe pelvic injury in motor vehicle collisions.

BACKGROUND: Pelvic fractures constitute a major cause of death and residual disability in motor vehicle collisions (MVC). To date there has been poor documentation of the epidemiology of severe pelvic injuries. A detailed retrospective examination of all abbreviated injury score (AIS) > or = 4 pelvic fractures sustained in occupants of MVCs seen at this lead trauma hospital over the last 12 years and in the province of Ontario over the last 6 years was completed. METHODS: The regional trauma centre registry and provincial database were used to obtain demographics, injuries, course in hospital and crash data on patients sustaining AIS > or = 4 pelvic injuries between May 1988 and April 2000. Data was analysed for drivers (D), front (FP) and rear (RP) passengers in 4-year blocks. Means (S.D.) with t-test for continuous and chi2 for categorical data were used for analysis. RESULTS: AIS > or = 4 pelvic fractures increased significantly in D and FP over 12 years and in RP over the last 8 years. Similar significant increases were seen throughout the province over the last 6 years. No significant change in age, sex, ISS or referral patterns was seen. Lateral impact collisions also increased over the study duration. Occupants with pelvic injury compared to all MVC survivors ISS > or = 16 during the same study period had a higher ISS (P < 0.001), utilised more blood in 24h and in total (P < 0.001) and died more frequently (P < 0.001). However, significantly fewer required ICU support (P < 0.01) which may reflect the associated injuries. Patients with pelvic fractures had significantly fewer head and chest injuries as well as fewer face and neck injuries. They did have significantly more injuries in the region of the pelvis including lumbar and sacral spine fractures, genitourinary, liver, spleen and lower extremity blood vessel, nerve and bone injuries. CONCLUSION: This study documented an increasing incidence of severe pelvic injury resulting from MVCs. This may be related to an associated increase in the incidence of lateral impact collisions. The role of side impact protection and side airbags, introduced to decrease injury severity in lateral impact collisions will require further study.

Accidents, Traffic↗
PubMed1987

Evaluation of cervicothoracic junction injury.

Cervical spine injury is a significant cause of morbidity and mortality in the traumatized patient. Little of the trauma literature addresses injury to the cervicothoracic junction (C7-T1); we were able to find only two studies that evaluated the incidence of injury in this area. The spinal injury registry of St Joseph's Hospital and Medical Center and Barrow's Neurological Institute in Phoenix, Arizona, was reviewed for cervical spine-injured patients. Of the 397 patients with cervical spine injury admitted between January 1980 and June 1985, 37 (9%) had cervicothoracic junction injury. Documentation of signs and symptoms of neck injury was recorded for each patient. All available lateral cervical spine radiographs were evaluated for indirect evidence of injury through the level of C7 as currently recommended in the trauma literature. Films were reviewed after being masked at the middle of the body of C7 thereby visualizing the C6-C7 junction. The incidence of C7-T1 injury in our cervical spine-injured population was 9%. Nine of the patients (24%) had a depressed level of consciousness and had neurologic examination that was not diagnostic of spinal injury. All of the cervical injuries in these patients were diagnosed by radiographic evaluation alone. We recommend that adequate visualization of the cervical spine through the cervicothoracic junction must be the standard for trauma care.

Arizona↗
PubMed1996

Sex differences in work-related injury rates among electric utility workers.

Few epidemiologic studies have evaluated sex differences in work-related injury rates. In this study, the authors examined injury trends by type of injury, severity of injury, and how the injury occurred among a cohort of 9,582 female and 26,898 male electric utility workers employed during 1980-1992 by the Southern California Edison Company. Sex-specific unadjusted injury rates were higher throughout the period for male workers. However, after adjustment for occupation, job experience, and age, elevated rate ratios indicate that female workers have higher injury rates. Mantel-Haenszel summary rate ratios and 95% confidence intervals were 1.49 (1.43-1.54) for all types of injuries, 1.27 (1.16-1.39) for head and neck injuries, 1.48 (1.38-1.58) for upper extremity injuries, 1.11 (1.01-1.21) for back injuries, and 2.11 (1.97-2.25) for lower extremity injuries. The rate ratios were slightly higher for more severe injuries, which suggests that potential reporting bias was not a likely explanation for these findings. The authors conclude that differences between male and female workers in training, physical capacity, task assignments, and other factors could explain these injury trends.

Accidents, Occupational↗
PubMed1984

Injuries of the cervical spine in schoolboy rugby football.

Serious neck injury in rugby football is becoming more common, especially in schoolboys. We report five who presented with spinal cord damage between 1977 and 1983, two in the 1982-83 season. The mechanisms of injury, the treatment, and the outcome are discussed. We suggest measures to reduce the incidence of this most serious injury and draw attention to the appropriate management in the critical phase directly after injury.

Adolescent↗
PubMed1989

Cranial symptoms after cervical injury. Aetiology and treatment of the Barré-Liéou syndrome.

Neck injury of the whiplash type may lead to the cranial symptoms of the Barré-Lieou syndrome. Forty patients with this syndrome and 40 without it were investigated by a variety of imaging techniques. There was a clear correlation between root sleeve defects at C3/4 shown by special oblique myelographic views and cranial symptoms. Good results were obtained by anterior cervical discectomy and fusion at C3/4 in 21 cases. It is suggested that the syndrome may result from irritation of the sympathetic nervous supply at this level.

Adolescent↗
PubMedDate not supplied

[Results of treatment of deep neck abscesses and phlegmons].

INTRODUCTION: Neck, as a structure very closely connected with oral cavity and pharynx, with great number of lymph nodes, (about 2, 3 of all are in the neck), is sometimes a localization of purulent inflammatory process but its incidence is not so high as the incidence of inflammations of surrounding organs and tissue. Deep neck abscesses are localized under the upper fascial layer. They have a serious clinical picture which could be further complicated if inflammation spreads on vessels or neck organs. If the processes spread toward the mediastinum because of the communication space between medial and deep fascial layer with mediastinum, it could be mediastinal inflammation with high mortality. The aim of this study is evaluation of results of treatment in patients with deep neck abscesses and phlegmons treated at Clinic in a ten year period (1988-1997). MATERIAL AND METHODS: This study comprised 21 patients who were treated at the ENT Clinic in Novi Sad during 1988-1997. The group consisted of 5 female and 16 male patients from one to 65 years of age. Sixteen (76.2%) patients were treated with antibiotics in general practice, and 5 were admitted without previous therapy, 8 patients were afebrile, with temperatures between 37-38 degrees C and 5 with fever and high temperature. In 17 patients 5 days passed from onset of symptoms to admittance at the Clinic, and 4 patients had enlarged neck lymph nodes a few months. Unknown primary site of infections were in 13 (61.9%) patients, that means abscesses developed as colliquation of inflammatory changed lymph node. In the rest of 8 patients abscesses developed as: oropharyngeal inflammation (4 patients), foreign body perforation of esophagus, chronic otitis media, neck injury, malignant lymphoma. Lateral side of the neck was the most frequent site of neck abscesses and phlegmon in 16 (76%) patients. Red skin over the abscesses didn't appear in 4 patients. In 2 patients neck emphysema developed: anaerobic inflammation in one patient and esophageal perforation in the second. In a patient with SE over the 50 per hour the length of the abscess was over 7 cm, and in those with SE over 100 per hour, the whole neck inflammed. All patients underwent surgical therapy between 24 to 48 h after admission with incision or excision of the abscesses. Pus was collected for culture during the incision or excision of the abscesses and phlegmon. Bacteria were discovered in specimens taken during the incision in 4 (19%) of patients. Different aerobic and anaerobic bacteria were isolated: Enterococcus, Peptostreptococcus sp, Streptococcus viridans, Clostridium species. Surgery was the basic therapy of neck phlegmons and abscesses. In all patients incision was sutured in the second stage. Only one patient got paralysis of n. accesorius. One patient died with gas gangrene of the neck. DISCUSSION AND CONCLUSION: Deep neck abscesses and phlegmons are relatively rare inflammations in spite of high incidence of surrounding tissue inflammations. The most frequent causes are inflammatory changes of lymph nodes. Treatment has to be urgent, because of vital neck structures and communications between deep neck space and mediastinum. We consider that surgery is the basic principle of therapy although we have not had experience with needle aspiration. Antimicrobial agents must be given only parenterally.

Abscess↗
PubMed1992

Effect of Gz forces and head movements on cervical erector spinae muscle strain.

A portable surface-integrated EMG (IEMG) device was used to investigate the strain caused by low and high Gz forces and head movements on the cervical erector spinae muscles during flight missions. The obtained IEMG activities were normalized by comparing them with activities representing maximal voluntary contraction (MVC) of the cervical erector spinae muscles in each subject. The muscular strain increased with increasing Gz forces and head movements. Under +7.0 Gz the mean muscular strain was 5.9-fold compared with +1.0 Gz and was 37.9% of the MVC. In some individuals, the muscular tolerance (100% of the MVC) was ipsilaterally reached already under +4.0 Gz with concomitant movements and twisted positions of the head. Pilots are susceptible to acute neck injury when the protection afforded by their neck muscles is insufficient.

Adult↗
PubMedDate not supplied

[Bleeding control in stab wounds to the great vessels at the neck base].

Stab wounds of the neck are a great challenge for every surgeon. Approximately 25% of penetrating neck injuries results in a vascular lesion. Wounds being situated below the cricoid cartilage are associated with the great mortality and morbidity, having a global mortality between 12-20%. 2/3 of the vascular wounds at this level have a tragic end. We are going to present 3 cases of cervical stab wounds in zone 1 of the neck, with vascular lesions, in which we succeeded to control the hemorrhages throw a midline sternotomy combined with different extensions. After this small experience we think that in patients with wounds situated in zone 1 of the neck, who reach the hospital hemodynamically unstable or with active bleeding, urgent midline sternotomy combined with cervicotomy, or section of the clavicle, is the best way to control the hemorrhages. Using blunt digital dissection we can avoid unpleasant situations that can appear using instrumental dissection into the mediastinal hematoma.

Adult↗
PubMed1999

Fatal laryngeal injury in an achondroplastic dwarf secondary to airbag deployment.

We report the case of an unrestrained driver with achondroplastic dwarfism who suffered a fatal anterior neck injury when her airbag deployed as she rear-ended another vehicle at 30-40 mph. Her short stature and short limbs required her to sit within a handbreadth of the steering wheel, which probably allowed the airbag or airbag cover to strike her neck as it opened. This is the first reported case of fatal injury to a driver with achondroplastic dwarfism.

Accidents, Traffic↗
PubMed2000

An investigation of hybrid III and living human drop tests.

The effect of roof crush on restrained occupants has often been discussed without regard to the headroom available, effectiveness of belts, and location of roof crush. In this article, the question of the ability to protect a simply restrained occupant in an environment in which the roof does not crush is addressed. The subjects were inverted and dropped vertically in noncrushable production vehicle compartments and a specially designed drop fixture. Data collected includes head accelerations, vehicle accelerations, head displacements, belt angles, anchor point location, seat position, and belt tension for a variety of occupant sizes. To our knowledge, these are the first inverted living human vertical studies to be scientifically documented and reported. It was found that no head or neck injuries resulted from drops of up to 91 cm and velocities up to 4.2 m/sec for restrained occupants in the absence of roof crush.

Accidents, Traffic↗
PubMed1979

Late false aneurysm of the carotid artery: repair with extra-intracranial arterial bypass.

A patient with a rapidly enlarging symptomatic false aneurysm of the internal carotid artery 30 years after nonoperative treatment of a penetrating neck injury is presented. Preoperative compression of the aneurysm precipitated transient cerebral ischemic attacks. Complete interruption of the right internal carotid artery inflow during aneurysmectomy was considered to be fraught with great danger. An extra-intracranial arterial bypass was therefore performed, and then aneurysmorrhaphy was easily performed and saphenous vein graft interposition accomplished. The importance of early definitive treatment of arterial injuries is emphasized. The bypass used allowed additional cerebral blood flow when complete occlusion of the carotid artery was contraindicated.

Aneurysm↗