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PubMedDate not supplied

Management of inadvertent injury to the carotid artery during head and neck surgery.

Rare, inadvertent injury to the carotid artery during head and neck surgery may result in disastrous neurologic sequelae or even death. Several cases are presented and used as the stimulus for an analytical discussion of the pathogenesis and management of cerebrovascular complications following head and neck surgery. The major pathogenetic mechanisms are identified as (1) microembolism from an ulcerated plaque; (2) intravascular thrombus with occlusion; (3) unintentional ligation, laceration, or transection; (4) ligation of a dominant external carotid; and (5) transient reduction in cerebrovascular perfusion pressure. Methods for identifying and evaluating the patient at risk for developing cerebrovascular complications are discussed and recommendations are made. The central question in the management of inadvertent arterial injury concerns whether to ligate the vessel or to restore blood flow. The controversies surrounding this issue are discussed in perspective through an analysis of current physiological concepts and of the collective clinical experiences of head and neck, vascular, and neurological surgeons handling extracranial cerebrovascular occlusive disease, penetrating injuries to the carotid artery, and tumor-related carotid catastrophes. Several factors are considered critical in determining appropriate management of any individual case; these include (1) whether recognition of the injury occurs intraoperatively or postoperatively; (2) the presence and severity of neurological deficits; (3) time from the injury to its recognition; (4) a quantitative assessment of collateral circulation; (5) a history of wound contamination or radiation therapy; (6) overall prognosis. These and other considerations are organized into a working framework through which the otolaryngologist and head and neck surgeon can better understand and manage the problem of inadvertent injury to the carotid artery.

Adult↗
PubMed1982

The abdomen in the patient with multiple injuries.

The body may be divided into three main areas for consideration of serious injuries: head and neck, trunk, extremities. Injuries to he head and neck give limited opportunity for effective medical treatment and early recognition is important. The trunk (chest and abdomen) is the site of of the most serious, life-threatening trauma. In abdominal injury there are three clinically and radiologically silent areas-the thoracic abdomen, the pelvis and the retroperitoneal space. In the thoracic abdomen there are injuries to three major organs: hepatic and splenic injuries, easily diagnosed by abdominal lavage, and diaphragmatic rupture, not easily diagnosed; only 25% of diaphragmatic ruptures present in a characteristic fashion. The others may show subtle abnormalities on the chest roentgenogram, such as slight blunting of the costophrenic angle and abnormal position of the nasogastric tube and stomach. In the pelvis there are also three organ systems that can be injured: the urinary tract, the rectum and the urinary bladder. In each case, the presence of blood - hematuria, gross or microscopic, and blood on the examining finger after rectal examination - signals the possibility of severe injury. The retroperitoneal space may also be the site of three important injuries - of kidney, usually flagged by developing hematuria; of pancreas and of retroperitoneal duodenum, each difficult to diagnose. Five signs may be present in a scout film of the abdomen: (a) slight scoliosis, (b) air in the duodenum, (c) no psoas shadow, (d) fracture of a lumbar vertebra or transverse process and (e) retroperitoneal air. Diagnosis and treatment must not be delayed.

Abdominal Injuries↗
PubMed2000

Incidence, site, and nature of injuries in amateur rugby league over three consecutive seasons.

OBJECTIVES: To report the incidence, site, and nature of injuries in amateur rugby league over three consecutive seasons. METHODS: Six hundred players registered with an amateur rugby league organisation were studied over three consecutive seasons. All injuries sustained during the amateur rugby league matches were recorded. Information recorded included the date and time of injury, name of injured player, anatomical site and nature of injury, and position of the player. RESULTS: The incidence of injury was 160.6 per 1000 player-position game hours, with forwards having a significantly higher incidence of injury than backs (182.3 per 1000 v 142.0 per 1000, chi2 = 14.60, df = 1, p<0.001). Over 25% of the total injuries (40.6 per 1000) sustained during the three year period were to the head and neck, while injuries to the face (21.3 per 1000, 13.3%), abdomen and thorax (21.3 per 1000, 13.3%), and knee (17.8 per 1000, 11.1%) were less common (chi2 = 21.83, df = 8, p<0.01). Muscular injuries (haematomas and strains) were the most common type of injury (45.7 per 1000, 28.5%, chi2 = 17.98, df = 7, p<0.05). Significantly more injuries occurred in the latter stages of the season (chi2 = 22.94, df = 1, p<0.001), with most injuries (70.8%, chi2 = 162.29, df = 1, p<0.001) sustained in the second half of matches. CONCLUSIONS: The results show that muscular injuries and injuries to the head and neck are the most commonly sustained injuries in amateur rugby league. Furthermore, injuries are more often sustained in the latter stages of the season and during the second half of matches. These findings suggest that fatigue or accumulative microtrauma, or both, may contribute to injuries in amateur rugby league players.

Athletic Injuries↗
PubMed2005

[Acute penetrating neck trauma presenting with laryngotracheal injury].

Laryngotracheal injuries are serious complications in the case of penatrating neck trauma which may not commonly in Japan. In the last several decades, many authors have discussed method for accurate evaluation and immediate airway management for patient with laryngotracheal injury. But, standardization of the treatment is still controversial about mandatory exploration or selective exploration. We report 4 cases with fresh laryngotracheal injury due to penetrating neck trauma including 3 suicide attempt patients. In these cases, laryngotracheoplasty used by absorbable material was performed within 8 hours after trauma. Two cases of suicide attempt patients underwent tracheostomy at the lower level of the laryngotracheal injury. After these treatment, fiberoptic bronchoscopy was performed to evaluate the airway for 3 cases except 1 who was dead because of hemorrhagic shock on arrival. In 2 cases, the suture filament existed in the lumen of the larynx and trachea, there were no major granulation in the site of repairment and no infection. Three cases were extubated successfully and discharged without major airway problem. Two cases have psychiatric disease such as depression, so we must consider their psychiatric background in the future. In conclusion, penetrating laryngotracheal trauma, we should consider that serious airway injury may be hidden under the superficial small wounds. Also, rapid local wound exploration and laryngotracheoplasty is important for life-saving, and fiberoptic bronchoscopy is effective to prevent early respiratory complications and has value in the evaluation.

Adult↗
PubMed2004

A novel rodent neck pain model of facet-mediated behavioral hypersensitivity: implications for persistent pain and whiplash injury.

Clinical, epidemiological, and biomechanical studies suggest involvement of cervical facet joint injuries in neck pain. While bony motions can cause injurious tensile facet joint loading, it remains speculative whether such injuries initiate pain. There is currently a paucity of data explicitly investigating the relationship between facet mechanics and pain physiology. A rodent model of tensile facet joint injury has been developed using a customized loading device to apply two separate tensile deformations (low, high; n = 5 each) across the C6/C7 joint, or sham (n = 6) with device attachment only. Microforceps were rigidly coupled to the vertebrae for distraction and joint motions tracked in vivo. Forepaw mechanical allodynia was measured postoperatively for 7 days as an indicator of behavioral sensitivity. Joint strains for high (33.6 +/- 3.1%) were significantly elevated (P < 0.005) over low (11.1 +/- 2.3%). Digitization errors (0.17 +/- 0.20%) in locating bony markers were small compared to measured strains. Allodynia was significantly elevated for high over low and sham for all postoperative days. However, allodynia for low injury was not different than sham. A greater than three-fold increase in total allodynia resulted for high compared to low, corresponding to the three-fold difference in injury strain. Findings demonstrate tensile facet joint loading produces behavioral sensitivity that varies in magnitude according to injury severity. These results suggest that a facet joint tensile strain threshold may exist above which pain symptoms result. Continued investigation into the relationship between injury mechanics and nociceptive physiology will strengthen insight into painful facet injury mechanisms.

Analysis of Variance↗
PubMed1986

[Injuries of the thoracic duct during neck surgery].

Although rarely published, operative injuries to thoracic duct in neck are by no means exceptional, and can occur during all types of surgery to lower cervical and supraclavicular regions. A case is reported and used as a basis for an analysis of diagnostic means and therapeutic possibilities of injuries detected during operation or those developing manifestations at a later stage. In the case reported, long-term medical treatment resulted in arrest of lymphorrhea within 37 days.

Adult↗
PubMed1956

Whiplash injuries.

Explore the source record for details and available documents.

Neck Injuries↗
PubMed1998

Operative treatment of truncal vascular injuries in children and adolescents.

BACKGROUND/PURPOSE: Pediatric truncal vascular injuries are rare, but the reported mortality rate is high (35% to 55%), and similar to that in adults (50% to 65%). This report examines the demographics, mechanisms of injury, associated trauma, and results of treatment of pediatric patients with noniatrogenic truncal vascular injuries. METHODS: A retrospective review (1986 to 1996) of a pediatric (< or = 17 years old) trauma registry database was undertaken. Truncal vascular injuries included thoracic, abdominal, and neck wounds. RESULTS: Fifty-four truncal vascular injuries (28 abdominal, 15 thoracic, and 11 neck injuries) occurred in 37 patients (mean age, 14+/-3 years; range, 5 to 17 years); injury mechanism was penetrating in 65%. Concomitant injuries occurred with 100% of abdominal vascular injuries and multiple vascular injuries occurred in 47%. Except for aortic and one SMA injury requiring interposition grafts, these wounds were repaired primarily or by lateral venorrhaphy. Nonvascular complications occurred more frequently in patients with abdominal injuries who were hemodynamically unstable (systolic blood pressure [BPS] <90) on presentation (19 major complications in 11 patients versus one major complication in five patients). Thoracic injuries were primarily blunt rupture or penetrating injury to the thoracic aorta (nine patients). Thoracic aortic injuries were treated without bypass, using interposition grafts. In patients with thoracic aortic injuries, there were no instances of paraplegia related to spinal ischemia (clamp times, 24+/-4 min); paraplegia occurred in two patients with direct cord and aortic injuries. Concomitant injuries occurred with 83% of thoracic injuries and multiple vascular injuries occurred in 25%. All patients with thoracic vascular injuries presenting with BPS of less than 90 died (four patients), and all with BPS 90 or over survived (eight patients). There were 11 neck wounds in 9 patients requiring intervention, and 8 were penetrating. Overall survival was 81%; survival from abdominal vascular injuries was 94%, thoracic injuries 66%, and neck injuries 78%. CONCLUSIONS: Survival and subsequent complications are related primarily to hemodynamic status at the time of presentation, and not to body cavity or vessel injured. Primary anastomosis or repair is applicable to most nonaortic wounds. The mortality rate in pediatric abdominal vascular injuries may be lower than previously reported.

Abdomen↗
PubMed1990

Selective management of penetrating neck trauma.

Of 110 patients with penetrating injuries of the neck, 58 were selectively observed and 52 underwent prompt surgical exploration according to defined criteria. In the group initially selected for observation, none required subsequent surgical intervention, and there was no mortality. Among those patients operated upon primarily, the negative exploration rate was 17 percent, and two patients died, both as a result of their injuries (mortality rate, 4%). We conclude that selective management of patients with penetrating neck injuries, when guided by repeated and careful examinations, is appropriate, does not increase the risk to patients, and avoids unnecessary surgical procedures.

Adolescent↗