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Cerebrovascular disruption frequently results from head and neck trauma. Injury to the extra- and intracranial carotid artery is uncommon but is associated with a high rate of death and permanent neurologic deficit. In this article, injuries to the carotid artery are reviewed with emphasis on the mechanisms, clinical manifestations, radiologic evaluation, and management of these traumatic lesions.
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It is important for the trauma surgeon to understand the basic principles of terminal gunshot ballistics and the study of the projectile's effect on striking soft tissue. The amount of kinetic energy dissipated to the tissue is directly related to the mass and velocity of the projectile as follows: K = MV2/2. Doubling the velocity quadruples the energy, while doubling the mass only doubles the energy. A temporary tissue cavity is produced as the striking projectile compresses the surrounding tissue; the higher the energy release, the more extensive the inapparent compressive damage. The permanent cavity that remains is the result of extrusion of tissue from the pathway of the projectile. The higher the velocity, the higher the likelihood of extensive damage. If the missile expands or fragments within the tissues, more damage will occur.
Iatrogenic injury to the spinal accessory nerve (SAN) during neck dissection may result in significant and avoidable morbidity in the form of 'shoulder syndrome'. The authors describe a simple method, based on the anatomy of the sternocleidomastoid muscle (SCM), which allows consistent and rapid identification of the SAN in the upper neck during dissection, thereby facilitating its preservation.
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Presents the methodological principles and succession of examination of the basic formations of the larynx in cases with blunt injuries of the neck. Describes variants of anatomic structure of the sublingual bone and laryngeal cartilages influencing the morphology of injuries thereof. Offers differential diagnostic criteria of various mechanisms of fractures of the basic formations and recommendations on medical criminological assessment of laryngeal injuries.
With increasing technologic advances in interventional radiology, the vascular surgeon should be well versed in the indications, limitations, complications, and results of percutaneous transcatheter embolization for arterial trauma. Three hundred twenty-eight angiographically determined arterial injuries occurred in 242 patients from 1977 to 1984 in a major city hospital trauma center and were studied prospectively. Transcatheter embolizations performed for 107 arterial injuries in 100 patients were successful in 82.2% of injuries. Gelfoam, minicoils, microcoils, intimal dissections, or a combination of modalities was utilized. Anterior and posterior element pelvic fractures associated with hypotension and transfusion of 6 units or more of blood required embolization in 28 patients. Bleeding was controlled in 85.7% of patients. Percutaneous transcatheter embolization was also effective in controlling 84.2% of arteriovenous fistulas, 88.9% of penetrating neck arterial injuries, and 73.3% of postoperative intra-abdominal hemorrhage. Therapeutic transcatheter embolization is a valuable adjunct to the vascular surgeon dealing with the spectrum of vascular trauma.
Because dentists routinely assess a patient's head, neck and mouth, they have a unique and excellent opportunity to recognize whether or not a patient is being abused. This article seeks to enlist the collaboration of the dental community in the effort to prevent domestic/intimate partner violence and provide more information about the signs and symptoms of domestic violence injuries, including strangulation, which is often overlooked by medical and dental professionals. Strangulation has only been identified in recent years as one of the most lethal forms of domestic violence. Unconsciousness may occur within seconds and death within minutes. It is known that victims may have no visible injuries whatsoever yet because of underlying brain damage by a lack of oxygen from being strangled, victims may have many serious internal injuries or die days or several weeks later. Strangulation is often indicative of a high level of domestic violence in a relationship. Attempted strangulation may cause physiological changes evident in the course of a dental examination. For these reasons, dentists should be vigilant in looking for its symptoms.
Bullet wounds are a rare occurrence during times of peace. Recently, however, there has been a general increase in the number and severity of this type of trauma in our case load. First, the possible firearms and the individual types of ammunition will be discussed. Based on this background, the possible types of wounds are presented. Principally, one distinguishes ricocheting shots from grazing ones, and those leaving bullets lodged in the body from those with perforating wounds. The extent of tissue damage depends on internal lacerations, on the compression of the tissue and on the temporary cavitation along the projectile path. In contrast to other types of injuries, which are caused by a blow or impact to the face or skull, gunshot traumas are characterized by an irregular path, as well as, by localized destruction of bones with associated effects. In this connection, the severity of the bullet wound also depends upon the extent of involvement of the viscerocranium. As causes of gunshot wounds during times of peace, suicidal intent, the negligent handling of firearms and especially brutal crimes are those which come into consideration first and foremost. The diagnostic aspect of firearm wounds, beside anamnesis, comprises comprehensive X-ray diagnostics for a complete picture. From the therapeutic side, tetanus serum and antibiotics as a prophylactic are recommended initially. The operative treatment should take place depending on the injury with the removal of a possible projectile. Bullet wounds always require an interdisciplinary approach to treatment.
Cervical pain is a prominent symptom in both acute whiplash injury and late whiplash syndrome. However, no systematic analysis of post-traumatic pain development covering several weeks has yet been performed in whiplash patients. It was the aim of the present study to analyse the duration and course of post-traumatic muscle pain due to whiplash injury in a prospective follow-up examination with short investigation intervals. A recovery of initially increased muscle pain after whiplash injury within 1 month was hypothesized. Pressure pain of the splenius and trapezius muscles was recorded using PC-interactive pressure algesimetry. Whiplash patients were investigated during the acute injury stage and after 3, 4, and 6 weeks and compared with matched controls. We found significantly increased pressure pain of the splenius and trapezius muscles in the acute stage of whiplash injury. After 4 weeks patients' scores of pain parameters were comparable to those of healthy control subjects. Within the patient group the first changes of pressure pain were observed within 3 (splenius) and 4 weeks (trapezius). For most patients the recovery dynamics lasted 4-6 weeks. A minority of patients did not show any improvement after 6 weeks. The present study shows that the dynamics of pressure pain due to whiplash injury can be quantified by means of PC-interactive pressure algesimetry. Our results confirm the clinical experience that the acute post-traumatic cervical syndrome normally subsides within weeks.
Most posttraumatic foreign bodies are metal objects in the heart, such as bullets and needles; nonmetal objects are very rare. We now report a case in which a piece of glass entered a girl's heart from an injury to the right side of her neck. Six months later, we successfully removed the glass shard from the anterior wall of the right ventricle.
Blunt carotid artery trauma is an uncommon but potentially dangerous clinical entity. We report eight patients from a 10-year interval who sustained blunt injuries to the carotid arteries. Six of eight patients suffered a hyperextension injury or had a cervical spine fracture or both. Arteriography revealed four arterial dissections and four thrombotic occlusions. Two asymptomatic common carotid artery occlusions and one dissection with transient ischemic attacks had successful arterial reconstructions. Five patients were treated nonoperatively: three internal carotid artery dissections with minor or no neurologic deficit; one asymptomatic thrombosis; and one internal carotid artery thrombosis with a major fixed neurologic deficit that did not improve. No patient died, and seven of eight made a complete neurologic recovery or remained asymptomatic. The diagnosis of blunt carotid artery injuries should be suspected in patients with neck hyperextension injuries or with cervical spine fractures as well as in patients with neurologic deficits not explained by intracranial trauma. Duplex scanning may be a useful noninvasive study. Surgery is indicated for selected patients with accessible lesions who have minor or no neurologic deficits. Asymptomatic patients with small intimal flaps or dissections may be successfully treated nonoperatively.
We reviewed our experience with tracheal and bronchial trauma from 1977 to 1988. There were 22 patients with tracheobronchial injuries treated in this period. Seventeen (77%) of the injuries were due to penetrating trauma and five (23%) were due to blunt trauma. Thirteen patients had major associated injuries, including six esophageal injuries. The most common physical findings were tachypnea (13 patients) and subcutaneous emphysema (nine patients). Eight patients presented with airway obstruction. All patients with penetrating cervical tracheal injuries underwent neck exploration and primary repair. All blunt injuries were diagnosed by bronchoscopy. Three patients with blunt injuries were treated with primary repair. Two patients with blunt chest trauma and small bronchial tears were treated nonoperatively with good results. All three deaths (14% mortality rate) were due to associated injuries. We conclude that patients with penetrating tracheobronchial injuries should be managed by surgical exploration and primary repair, although selected patients with blunt injury may be treated nonoperatively.
After spinal cord injury, quadriplegic patients generally require tracheostomy for ventilatory support and airway clearance. Early tracheostomy has several advantages over translaryngeal intubation, but in patients who undergo anterior surgical fixation of the spine, it is often delayed until after recovery of the surgical wound. We report the case of a quadriplegic patient who underwent a successful percutaneous dilational tracheostomy with the Ciaglia technique after surgical fixation of the spine. The percutaneous dilational technique minimizes the injury to the adjacent structures of the neck and the risk of stomal infection. Therefore, it should be considered the technique of choice when an early tracheostomy is indicated for quadriplegic patients who have undergone anterior surgical fixation of the cervical spine.
The authors present a case of bilateral Hawkins type II talar neck fractures sustained during a motocross race in a 23 year old man. Due to the complexity of the injuries, open reduction with internal fixation and primary subtalar joint arthrodesis was performed bilaterally. This is one of the few cases of bilateral talar neck fractures reported in the literature in the past 15 years and one of the first utilizing open reduction and internal fixation with concomitant subtalar joint arthrodesis as a primary treatment.
BACKGROUND/OBJECTIVE: The incidence of head/neck trauma preceding cervical dystonia (CD) has been reported to be 5-21%. There are few reports comparing the clinical characteristics of patients with and without a history of injury. Our aim was to compare the clinical characteristics of idiopathic CD (CD-I) to those with onset precipitated by trauma (CD-T). METHODS: We evaluated 114 consecutive patients with CD over a 9-month period. All patients were interviewed using a detailed questionnaire and had a neurological examination. Their clinical charts were also reviewed. RESULTS: Fourteen patients (12%) had mild head/neck injury within a year preceding the onset of CD. Between the two groups (CD-I and CD-T), the gender distribution (F:M of 3:2), family history of movement disorders (32% vs. 29%), the prevalence of gestes antagonistes (65% vs. 64%), and response to botulinum toxin were similar. There were non-specific trends, including an earlier age of onset (mean ages 43.3 vs. 37.6), higher prevalence of neck pain (86% vs. 100%), head tremor (67% vs. 79%), and dystonia in other body parts (23% vs. 36%) in CD-T. CONCLUSIONS: CD-I and CD-T are clinically similar. Trauma may be a triggering factor in CD but this was only supported by non-significant trends in its earlier age of onset.