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At least 739 records · Page 41Linked to original sources
PubMed1995

Traumatic carotid and vertebral artery dissection in a professional jockey: a cautionary tale.

Jockeys accept bony fractures and soft tissue injuries as occupational hazards. An average National Hunt jockey falls once in ten races with an injury rate of 4.25%. Head injury is a common cause of morbidity and the benefit of helmets is well recognized. Neck injuries are also common and usually musculoskeletal. Although rare, trauma to the neck arteries may go unnoticed yet have catastrophic consequences. Internal tears can allow arterial blood to dissect the layers of the arterial wall and obstruct the lumen. Severe obstruction may lead to cerebral ischaemia and infarction. An appreciation of the early clinical signs caused by this process may allow effective intervention. We report a case which illustrates these points.

Adult↗
PubMed1999

Surgical emphysema and pneumomediastinum in a child following minor blunt injury to the neck.

Largyngotracheal and pharyngoesophageal tears following minor blunt trauma to the neck are uncommon. A child with such an injury is reported and the modes of diagnosis and management are discussed. Patients may initially present with minimal signs and symptoms, but their condition may deteriorate rapidly or insidiously. In the absence of respiratory compromise, conservative management is appropriate, but all patients with significant blunt neck trauma should undergo early direct laryngoscopy under a general anaesthetic.

Child, Preschool↗
PubMed2005

Combined laryngotracheal separation and esophageal injury following blunt neck trauma.

In this article we describe the first case of combined laryngotracheal and esophageal injury following blunt neck trauma in the otolaryngology literature and delineate appropriate management considerations. Successful reconstruction requires appropriate airway management, restoration of esophageal and laryngeal mucosal integrity, and reduction of tracheal and laryngeal fractures with appropriate stenting. Laryngotracheal separation following blunt neck trauma is rare and can be initially overlooked. After the airway is secure, injury severity dictates repair and postoperative care. Immediate reconstruction with restoration of the laryngotracheal framework and mucosal integrity enables patients to recover a patent airway, functional voice, and normal swallow.

Adult↗
PubMed2001

Headaches in the whiplash syndrome.

STUDY DESIGN: A prospective clinical analysis of headaches in whiplash injury. OBJECTIVES: To provide a detailed clinical account of the nature, characteristics and natural history of headaches, and to examine their possible relation to the neck injury. SETTING: One medicolegal practice in UK. METHODS: This study consists of a prospective clinical analysis of headache symptoms in consecutive patients referred to the author for medicolegal assessment of whiplash injury, with no special reference to headaches. RESULTS: All 80 patients noted neck pain. Headaches were related as a consequence of the accident by 48 patients (60% of the total). The circumstances of injury did not differ from whiplash victims who did not have prominent headache. The headache onset was maximum in the first 24 h after injury. The failure to recall well documented pre-accident headaches in almost one fifth of patients is significant. The common types of headaches were non-specific, generalised, dull, aching pain (25 patients), a mixtures of aching and tightness, and tension type headache. Only three (6%) had migraine without aura. CONCLUSION: Post-whiplash headache is a genuine common but short lived affair, constant headaches disappearing within 3 weeks in 85% subjects. In the minority complaining of headache after that period there was no evidence of persisting physical injury, nor of inability to work or other disability caused by headaches.

Adolescent↗
PubMed1994

[Determining the status of the cervical spine after whiplash injury].

The results of medical investigations following acceleration mechanism to the cervical spine (so called "soft tissue neck injury") are to be described in common diagnostic terms. Biomechanical and legal considerations are beyond medical competence. In certain cases, the clinical examination must be completed in cooperation with specialists. Within the entire medical context, the neuropsychological and neuropsychiatric assessment may contribute to a comprehensive understanding of the consequences. In cases of litigation, the full array of facts, like the patients' previous history, and differential diagnoses, have to be drawn to attention. At present, compensation takes place only exceptionally and in a limited range, if an impairment by an accompanying brain injury is excluded.

Accidents, Traffic↗
PubMed1997

Completely dislocated hangman's fracture with a locked C2-3 facet. Case report.

The authors report a rare case of a hangman's fracture involving complete dislocation of C-2 onto C-3, accompanied by a C2-3 locked facet and asymptomatic bilateral vertebral artery injuries. The patient, a 25-year-old man who sustained a neck injury in an industrial accident, presented with a mild central spinal cord syndrome. His initial lateral cervical radiograph showed complete anterior dislocation of the C-2 body onto C-3, bilateral neural arch fractures, and a unilateral locked facet. The mechanism was likely flexion and compression. The grossly unstable spine and the locked facet were treated by posterior decompression, reduction, and C1-3 fixation. The patient recovered in several days and is without neurological deficit.

Adult↗
PubMed2000

Combined carotid artery injury and laryngeal fracture secondary to dog bite: case report.

Approximately 914 new dog bite injuries requiring emergency department visits occur daily in the United States. Attacks by dogs with training and strength to attack should be triaged cautiously because of the possibility of serious internal injury. A high index of suspicion is needed when treating patients with neck injuries secondary to dog bites. We report a case of successfully treated combined carotid artery and laryngeal injury produced by a dog bite.

Adult↗
PubMed1982

Baby walker injuries.

In a study of 49 children between the ages of 8 and 14 months, parents were surveyed with a written questionnaire and a follow-up phone interview to determine the utilization of baby walkers and the frequency and severity of baby walker injuries. Most respondents (86%) placed their children in various types of baby walkers between 4 months and 1 year of age. Half of the 42 infants who used walkers experienced at least one accident involving a tip over, a fall down stairs, or finger entrapment. Two of those accident resulted in injuries serious enough to require medical management. Both infants sustained head and neck injuries after falling down stairs in a walker. Whereas stairway and finger entrapment accidents occurred before the age of 7 months, tip overs were much more likely to occur after the age of 8 months. Injuries are more common but less severe than previously reported. Pediatricians and other child health advocates can inform parents about the health risks, encourage regulatory agencies to improve product labeling, and stimulate manufacturers to adjust the product to age and weight specifications of the growing infant.

Accidents, Home↗
PubMed1996

[Suicidal knife injuries of the neck].

During a 10-year period at the Otorhinolaryngology Clinic in Novi Sad (1984-1994), there were 19 patients with suicidal knife injuries of the neck. There were two mechanisms of injuries: cuts in 15 (78.9%) patients and stabs in 4 (21.10%). 9 injured patients had cut structures and open pharynx, 6 patients injured larynx and trachea, 2 injured only trachea and 2 patients injured pharynx and larynx. 3 (15.8%) patients had knife self-injuries on other parts of the body too, that is injuries of abdomen, top of the right lung lobe and wrist. The diagnosis was based on anamnestic data, clinical check-up, pharyngeal, laryngeal and esophageal directoscopy. Surgery was performed in less than 24 hours after injury. Injuries were successfully taken care of and swallowing, breathing and phonation were reestablished in 16 (84.2%) patients. Total laryngectomy with pharyngoplasty was performed in one patient with serious hypopharyngeal and esophageal injuries. Two patients (10.5%) died: one in the state of delirium tremens and one in serious hemorrhagic and traumatic shock.

Adult↗
PubMed1999

Transient mutism resolving into cerebellar speech after brain stem infarction following a traumatic injury of the vertebral artery in a child.

A 3.7-year-old girl presented with an anterior neck injury followed by progressive subcutaneous emphysema and loss of consciousness. After resuscitation, a laceration on the first tracheal cartilage was closed surgically. As she was extubated one week later, she was found to have right hemiplegia and muteness. MRI showed a T2-bright lesion on the tegmentum of the left midbrain down to the upper pons. Right vertebral angiography disclosed an intimal flap with stenosis at the C3 vertebral level presumably caused by a fracture of the right C3 transverse process later confirmed in a cervical 3D-CT scan. Her muteness lasted for 10 days, after which she began to utter some comprehensible words in a dysarthric fashion. Her neurological deficits showed improvement within 3 months of her admission. Transient mutism after brain stem infarction has not been reported previously. We discuss the anatomical bases for this unusual reversible disorder in the light of previous observations and conclude that bilateral damage to the dentatothalamocortical fibers at the decussation of the superior cerebellar peduncle may have been responsible for her transient mutism.

Brain Mapping↗
PubMed1999

Patterns of maxillofacial injuries in powered watercraft collisions.

Because of the widespread popularity of water sports, plastic and reconstructive surgeons can expect to manage an increasing number of injuries associated with these activities, particularly those related to powered watercraft vehicles. Although seat belts for motorists and helmets for motorcyclists may be efficacious, such devices currently do not serve a similar role in powered watercraft sports. In this study, a retrospective chart review of 194 consecutive patients who presented to the University of Miami/Jackson Memorial Hospital (Level I trauma center) as a result of powered watercraft collisions is presented. The purpose of this investigation was to assess the incidence, cause, demographics, and available management options for head and neck injuries secondary to powered watercraft. Identified were 194 patients who presented because of watersports-related injuries during the period January 1, 1991, through December 31, 1996. From this group, 81 patients (41.8 percent) sustained injuries directly attributable to powered watercraft collisions, including 41 personal watercraft collisions (50.6 percent), 39 boat collisions (48.1 percent), and 1 airboat collision (1.2 percent). The patient population, as expected, tended to be young and male with an average age of 29 years (range, 8 to 64 years old). Interestingly, 41 of the patients (50.6 percent) who presented to this trauma center as a result of powered watercraft collisions also sustained associated head and neck trauma. Of 74 injuries 24 were facial fractures (32.4 percent), 18 were facial lacerations (24.3 percent), 14 were closed head injuries (18.9 percent), 8 were skull fractures (10.8 percent), 4 were scalp lacerations (5.4 percent), 4 were C-spine fractures (5.4 percent), 1 was an ear laceration (1.4 percent), and 1 was a fatality (1.4 percent). Le Fort fractures were the most commonly identified facial fracture in this series. The number of these injuries seen in hospital emergency rooms will most likely increase in the future as the popularity of water-related recreational activities becomes even more widespread. Based on these findings, it is strongly recommended that future efforts be directed toward the prevention of these injuries through patient education and the eventual development of efficacious and safe protective equipment.

Accidents↗
PubMed2005

Penetrating pharyngeal injuries in children: trivial trauma leading to devastating complications.

Pharyngeal perforations are uncommon in children and are usually secondary to instrumentation or external penetrating injuries. A delay in management can lead to life-threatening complications such as retropharyngeal abscess, mediastinitis, and airway compromise. We report three children who had pharyngeal perforation due to apparently innocuous injury and who developed serious complications. A high index of suspicion for a significant pharyngeal injury, use of lateral soft-tissue x-ray films of the neck, and flexible endoscopy in the emergency room can assist in early diagnosis when evaluating patients with oropharyngeal and penetrating neck injury. Prompt administration of broad-spectrum antibiotics, local drainage, and debridement can avert life-threatening complications.

Abscess↗
PubMed2003

Effect of the helmet act for motorcyclists in Thailand.

OBJECTIVES: This study investigated the effect of the helmet act for motorcyclists on increasing helmet use and reducing motorcycle-related deaths and severe injuries in Thailand. METHODS: Data were derived from a trauma registry at the Khon Kaen Regional Hospital in the northeast Thailand. Helmet use and outcome in motorcycle crashes were compared 2 years before (1994-1995) and after (1996-1997) enforcement of the helmet act. During the study period, there were 12002 injured motorcyclists including 129 death cases in the municipality of Khon Kaen Province who were brought to the regional hospital. RESULTS: After enforcement of the helmet act, helmet-wearers increased five-fold while head injuries decreased by 41.4% and deaths by 20.8%. Those who had head or neck injuries or died were less likely wearing a helmet. Compliance of helmet use was lower at night. Fatality of injured motorcyclists did not significantly decrease in the post-act period and among helmet-wearers. CONCLUSION: Enforcement of the helmet act increased helmet-wearers among motorcyclists but helmet use did not significantly reduce deaths among injured motorcyclists. Motorcyclists should be instructed to properly and consistently wear a helmet for their safety.

Accidents, Traffic↗
PubMedDate not supplied

Axial loading injuries to the middle cervical spine segment. An analysis and classification of twenty-five cases.

Injuries to the cervical spine at the C3-C4 level involving the bony elements, intervertebral disks, and ligamentous structures are rare. We present 25 cases of traumatic C3-C4 injuries sustained by young athletes and documented by the National Football Head and Neck Injury Registry. Review of the cases reveals that the response of energy inputs at the C3-C4 level differ from those involving the upper (C1-C2) and lower (C4-C5-C6-C7) cervical segments. Specifically, the C3-C4 lesions appear to be unique with regard to the infrequency of bony fracture, difficulty in effecting and maintaining reduction, and a more favorable recovery following early, aggressive treatment. In the majority of instances, injury at this level results from axial loading of the cervical spine. Lesions were distributed into specific categories: 1) acute intervertebral disc herniation (N = 4), 2) anterior subluxation of C3 on C4 (N = 4), 3) unilateral facet dislocation (N = 6), 4) bilateral facet dislocation (N = 7), and 5) fracture of vertebral body C4 (N = 4). Analysis of these 25 cases suggests that traumatic lesions of the cervical spine in general can be classified as involving the upper (C1-C2), middle (C3-C4), or lower (C4-C7) segments. This is based on our observations from this series that C3-C4 lesions 1) generally do not involve fracture of the bony elements; 2) acute intervertebral disc herniations are frequently associated with transient quadriplegia; 3) reduction of anterior subluxation of C3 on C4 is difficult to maintain; 4) reduction of unilateral facet dislocation is difficult to obtain by skeletal traction and is best managed by closed manipulation and reduction under general anesthesia; and 5) reduction of bilateral facet dislocation is difficult to obtain by skeletal traction and is best managed by open methods. The more favorable results observed in this series of immediate reduction of both unilateral and bilateral facet dislocations deserves emphasis. In two cases of unilateral facet dislocation reduced within 3 hours of injury and subsequently fused anteriorly, significant neurologic recovery occurred. The other four patients, two who underwent an open reduction and laminectomy and two treated closed with skeletal traction, remained quadriplegic. In the four instances of bilateral facet dislocation where reduction was achieved by either closed or open methods, although there was no neurologic recovery, all four patients survived their injuries. However, the three patients who were not successfully reduced died.

Adolescent↗
PubMed1987

Spinal injury at the level of the third and fourth cervical vertebrae resulting from the axial loading mechanism: an analysis and classification.

The traumatic C3-C4 level injuries sustained by young athletes and documented by the National Football Head and Neck Injury Registry are discussed. Twenty-eight of 885 (2.8 per cent) injuries involved the C3-C4 vertebrae. Review of these cases reveals that the response to energy inputs at the C3-C4 level differ from that of those involving the upper (C1-C2) and lower (C5-C6) cervical segments. Specifically, these lesions appear unique with regard to infrequency of bony fracture, difficulty in effecting and maintaining reduction, and their more favorable response to early aggressive treatment. It is the authors' belief that these lesions resulting from athletic activity are due to axial loading.

Adolescent↗
PubMed1993

Endoscopic evaluation of penetrating esophageal injuries.

There are few objective data evaluating the role of flexible endoscopy in the management of penetrating esophageal and neck injuries. A retrospective analysis was performed on 13 trauma patients who had undergone emergent esophagogastroduodenoscopy for the evaluation of potential esophageal injuries. Endoscopy resulted in one true positive (esophageal injury detected), 10 true negatives (normal esophagus), two false positives, and no false negatives. This yielded a sensitivity of 100% and specificity of 83%. There were no complications of endoscopy. We conclude that urgent flexible esophagogastroduodenoscopy is a useful diagnostic procedure in the evaluation of penetrating wounds possibly involving the esophagus.

Adult↗
PubMed1995

[Surgical treatment in stab and cut wounds of the neck with esophageal injury].

The author describes methods of surgical treatment of people wounded in the neck area with injuries of the esophagus. Clinical observations are presented which show that breach of the rules of revision of the wound canal and organs of the neck will inevitably lead to a diagnostic error. The method and volume of the surgical intervention for wounds of the esophagus depend on the kind of the injury and time from the moment of trauma.

Adult↗