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At least 19 recordsLinked to original sources
PubMed1991

Management of penetrating neck injuries. The controversy surrounding zone II injuries.

Penetrating neck injuries present a difficult challenge in management, given the unique anatomy of the neck. Controversy surrounds the approach to zone II injuries; mandatory versus selective exploration. On the basis of an extensive literature review, the authors conclude that neither approach is obviously superior. A selective approach is safe in the asymptomatic and hemodynamically stable patient, provided that accurate invasive diagnostic means are immediately available. The mandatory approach is safe, reliable, and time tested. The greatest problem appears to be the accuracy of detection of cervical esophageal injuries: Radiologic evaluation may be inaccurate, rigid esophagoscopy carries a risk of perforation, and the injury may easily be overlooked during surgical exploration.

Carotid Artery Injuries↗
PubMed1986

Neck injuries in football players.

Understanding neck injuries in football players starts with understanding how the game is played--not the strategy, but the training techniques and requirements of the game. Neck injuries are an unavoidable part of the game. What can be improved are the preventative measures, the treatment techniques, and some standardization of risk factors in playing after a neck injury. Prevention starts with decreasing the use of the head as an offensive weapon and with proper shoulder pads. Treatment begins with proper on-field evaluation and transportation techniques and is completed by good consultation services. Proper evaluation of risk demands open discussions with the patient of all factors involved. Clear advice is given to players and to the team through their medical staff.

Adolescent↗
PubMed1991

[Penetrating neck injuries].

The frequency of penetrating neck injuries has increased in recent years. In 16 patients with such injuries treated during the past 2 years, neck exploration was performed immediately. In 4 there was destruction of the throat or trachea, in 3 a tear in the esophagus, in 1 a tear in the hypopharynx and in 1 a tear in the submandibular region penetrating the floor of the mouth. In 8 there was no damage to the neck organs. Of the 16, 1 died on the operating table from hemorrhage from multiple tears of the hypopharynx, the esophagus and the thyroid gland. 2 different approaches are used in dealing with penetrating neck injuries: immediate exploration, or the use of imaging methods to diagnose the degree of damage, followed by close supervision. In the light of our experience we advocate immediate neck exploration.

Humans↗
PubMedDate not supplied

Head and neck injuries in college football: an eight-year analysis.

The present study documented head and neck injuries in a study group of 342 college football players at a single institution for a period of 8 years. All freshmen players were screened for evidence of: (1) past history of head and neck injuries, and (2) abnormalities of the cervical spine on physical examination and x-ray film. By recording all head injuries and those neck injuries with time loss, incidence rates and patterns of injury incurred in college competition were determined. A total of 175 head and neck injuries were sustained by 100 players over the 8 year period. Those players with abnormal findings on screening examination were twice as likely to have a head or neck injury at some point in their college careers as those players with a normal screening examination. The greater the degree of abnormality on freshman screening examination, the more severe the neck injury in college was likely to be. Twenty-nine percent of all players in the study group sustained a head or neck injury during their college careers. The probability of a subsequent head or neck injury escalated sharply following a single incident. The overall incidence of injury was found to have been dramatically reduced over the 8 years. Influential factors such as legislative rule changes, medical status of recruits, and general coaching philosophies are discussed with regard to injury reduction and prevention of head and neck injuries in college football.

Adult↗
PubMed1986

Head and neck injuries.

A survey of cranial, intracranial and neck injuries caused by blunt trauma to the head is presented. The different types of fractures to the skull (impression fractures, linear fractures and ring fractures) are discussed as well as the injury mechanisms. Brain injuries are discussed under the heading of focal brain injury (i.e. brain laceration, cortical contusion, hemorrhages of the meninges and traumatic intracerebral hemorrhages). The different types of neck injuries, including atlanto-occipital dislocation, are listed and the stability of the different fractures are discussed. Facial injury is not included.

Atlanto-Axial Joint↗
PubMed1988

Period prevalence of acute neck injury in U.S. Air Force pilots exposed to high G forces.

Neck injury is an unquantified clinical and epidemiological problem in pilots exposed to high G forces. The description and assessment of potential deleterious effects on the cervical vertebrae are important aspects of occupational preventive aerospace medicine. This report presents the findings from a prevalence study of acute neck injury, resulting from high G forces, in pilots of high performance aircraft. A sample of 437 pilots from three different aircraft with varying performance capabilities was surveyed by means of an anonymous questionnaire. Stratified sample data were analyzed to determine the strength of association of injury prevalence with pilot age, type of aircraft, and type of flying environment. Of the surveyed pilots, 50.6% stated they had some type of acute neck injury in the preceding 3-month period. Higher aircraft performance was associated with increased injury prevalence. Increased age was associated with increased prevalence of major injury. Preventive strategies may be helpful in reducing injury frequency and avoiding serious injuries.

Acceleration↗
PubMed1992

[Neck injuries].

Diagnostic work-up of neck injuries is dependent on vital signs, neurologic status and location of the wound. Patients who are haemodynamically unstable, who exhibit current arterial bleeding, expanding or pulsatile haematoma or respiratory distress after initial resuscitation are taken to the operating theatre without further delay. Patients who present stable vital signs or who are stable after resuscitation are subjected to further evaluation. Penetrating wounds below the cricothyroid membrane (zone I) and just below the clavicle and above the mandibular angle (zone III) are subjected to angiography. Explorations in these regions are associated with considerable morbidity and routine exploration is not warranted. Injuries between the cricothyroid membrane and mandibular angle are easily reached, and routine exploration is recommended. Selective diagnostic work-up with angiography, oesophagography and laryngotracheobronchoscopy is an alternative if available on a 24 hour basis. The common and internal carotid arteries are repaired in patients with focal or no neurologic deficit, and in patients with equivocal neurologic status secondary to hypoperfusion or intoxication. Ligation is performed if reconstruction is not feasible. Appropriate treatment of the comatose patient remains controversial. Oesophageal and tracheal injuries are primarily repaired.

Emergencies↗
PubMed1990

Soft tissue neck injuries--a review.

The current state of knowledge about soft tissue neck injuries has been described. Much progress made in establishing exact mechanisms of injury and in accurate diagnosis and treatment of injury. Certain symptoms and signs soon after injury has been shown to be poor prognostic factors for recovery. Although much progress has been made in many important areas of concern there is much that remains to be learned about soft tissue neck injuries.

Esophagus↗
PubMed1992

Three-dimensional head kinematics and clinical outcome of patients with neck injury treated with spinal manipulative therapy: a pilot study.

OBJECTIVE: Finite helical axis parameters (FHAP) of the cervical spine and clinical measures were obtained to evaluate neck function and the clinical effects of spinal manipulative therapy in patients with "whiplash" (WL) type neck injury. DESIGN: Descriptive case series, 1 yr follow-up. SETTING: Three private chiropractic practices. SUBJECTS: Ten consecutive new patients with a history of neck injury, nine asymptomatic, volunteer controls. INTERVENTIONS: A 6-wk regimen of short lever manually assisted adjustments with an Activator Instrument, while acute, four patients received interferential electrotherapy. MAIN OUTCOME MEASURES: Cervical FHAP during normal movements, neck pain (visual analogue scale), active cervical range of motion and follow-up questionnaire. RESULTS: Based on six patients, the FHAPs appeared to mirror the clinical condition, being markedly deviant from the patterns observed in the control group for at least one or more of the tracking tasks for all but one of the patients. Mean pain scores decreased from 44.1 to 10.5 (t = 4.93; p < .0001) and mean total range of motion increased from 234 to 297 degrees (t = 5.68; p < .0001). At 1 yr, seven respondents noted stability of their symptoms at or near the level reported immediately after the 6-wk treatment period. CONCLUSIONS: Based on these preliminary data: a) FHAPs may aid in diagnosing and monitoring treatment of neck dysfunction, b) spinal manipulative therapy may be beneficial to some patients with neck injury and future study is warranted as a means to promote recovery of patients with neck injuries.

Adult↗
PubMed1989

An evaluation of proposed causal mechanisms for "ejection associated" neck injuries.

A major concern to the U.S. Navy has been the incidence of neck injuries sustained in aircraft ejections. Some of these injuries result in lost work days, some require specialized medical treatment and, occasionally, a neck injury is fatal. The net effect of such injuries is to increase the difficulty and cost of achieving specific levels of fleet operational readiness. At the same time, the occurrence of such injuries reduces aircrew confidence in the efficiency and safety of their escape systems. This study was the continuation of a study reported by one of the authors in 1983 (2), and this paper presents the current results in attempting to narrow the field of possible contributing factors and to possibly identify the more significant causal factors and mechanisms.

Aircraft↗
PubMed1986

The necessity of mandatory exploration of penetrating zone II neck injuries.

To reevaluate the validity of our policy of mandatory surgical exploration of penetrating zone II neck injuries, the charts of 110 patients who underwent surgical exploration for such injuries were reviewed. Fifty-three percent of the patients had normal findings at exploration, whereas 33% had injuries involving vascular structures of the neck and 14% had nonvascular injuries. Injuries were not suspected on clinical grounds preoperatively in 23% of the patients in whom surgical exploration revealed injury. The injuries most likely to escape preoperative diagnosis were isolated venous injuries and isolated pharyngoesophageal injuries. Arteriography yielded false-negative results in two arterial injuries. No deaths and only a 5% incidence of minor complications occurred in the group with no injuries detected at exploration. We conclude that surgical exploration of penetrating zone II neck injuries is safe and appropriate.

Adolescent↗
PubMed1979

The National Football Head and Neck Injury Registry. Report and conclusions 1978.

The National Football Head and Neck Injury Registry has documented 1,129 injuries since 1971 that involved hospitalization for more than 72 hours, surgical intervention, fracture-dislocation, permanent paralysis, or death. Of this group of injuries, 550 were fracture-dislocations of the cervical spine, of which 176 were associated with permanent quadriplegia. It appears that during the last two decades, there has been a decrease in the incidence of direct fatalities, head injuries associated with intracranial hemorrhage, and injuries associated with death. Conversely, cervical spine injuries with fracture-dislocation and with permanent quadriplegia have increased. We believe that these observations are the result of the development of a protective helmet-face mask system that has effectively protected the head, and by so doing has allowed it to be used as a battering ram in tackling and blocking techniques, thus placing the cervical spine at risk of injury.

Athletic Injuries↗
PubMed1986

The effect of head restraints and seat belts on the incidence of neck injury in car accidents.

During a 5-month period a study was made of motor vehicle occupants presenting at an Accident and Emergency department following an accident. Records were made of the incidence of neck injuries in relation to the presence of head restraints and the use of seat belts. There was a slight reduction in injuries when a head restraint was fitted but this difference did not achieve statistical significance. The incidence of neck injury was not increased if a seat belt was worn. It may be that the reason for the failure of head restraints to afford the expected protection is their inappropriate design and lack of adequate adjustability.

Accidents, Traffic↗
PubMed1991

Penetrating zone-II neck injuries in children.

Over a 4-year period, 1,237 children under 16 years of age were managed at our level-I pediatric trauma center, of which 24 (1.9%) had zone-II penetrating neck injuries. Six of these 24 children (25%) were explored surgically with positive findings in four and negative findings in two neck explorations; five children (21%) underwent radiologic or endoscopic studies and were observed; 13 (54%) were observed only and did not require studies or exploration. Nonoperative observation of penetrating zone-II neck injuries is safe and the procedure of choice if active observation can be performed and the facilities for immediate operative intervention are available.

Adolescent↗
PubMed1979

[Head and neck injuries in equestrian accidents (author's transl)].

Horses' kicks can produce two types of head and neck injuries: injuries of the mid-face and injuries of the larynx. Typical cases as seen by the author are presented. The treatment of mid-face injuries is performed according to principles of plastic surgical repair. After frontal-nasal injuries, a revision of the nasal septum must be done. Involvement of the larynx requires external layer repair of mucosa and cartilage.

Adult↗
PubMed1992

Are arteriograms necessary in penetrating zone II neck injuries?

The evaluation and management of potential arterial injuries in penetrating neck trauma are controversial. Routine surgical exploration or arteriography can be very expensive and time-consuming and can overburden available resources if used in all patients. We reviewed the records of 4035 patients seen in our trauma center during a 20-month period and identified a total of 110 patients (2.7%) with penetrating wounds to zone II of the neck; 50 were from gunshot wounds, 43 from stab wounds, 7 from shotgun injuries, and 10 from lacerations. In 42 (39%) patients there was no arteriogram or surgery based on location of the wounds or lack of any physical findings. None of these patients later had any evidence of an arterial injury. Forty-five patients (40%) had arteriograms based on proximity or a "soft" sign of vascular injury, which included evidence of significant bleeding or a stable hematoma. A total of 15 injuries to major arteries were identified: 3 common carotid, 5 internal carotid, and 7 vertebral. One patient died during initial resuscitation, and four patients went directly to surgery with no preoperative arteriogram for active bleeding and expanding hematoma (n = 1), an expanding hematoma (n = 2), and a large, stable hematoma (n = 1). Only one patient (of the 110) had a significant major arterial injury requiring surgery that was not predicted by physical findings. Nine arterial injuries were treated nonoperatively: six vertebral, two common carotid intimal flaps, and one small distal internal carotid pseudoaneurysm (diagnosed late). Three additional minor external carotid artery injuries were observed with no adverse sequelae.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1989

A study of upper limb pain and paraesthesiae following neck injury in motor vehicle accidents: assessment of the brachial plexus tension test of Elvey.

The brachial plexus tension test (BPTT) appears to offer a means of examining the extensibility and mechanosensitivity of the neural tissues related to an upper limb. This test was used to evaluate possible cervical or brachial plexus neural involvement causing arm pain syndromes in 37 patients presenting for assessment following neck injury in motor vehicle accidents. The BPTT was considered positive in 55 of the 61 symptomatic arms. There were no false-positive responses in the 13 asymptomatic arms although a slight loss of extensibility was evident in five arms. Twenty patients without clinical evidence of current or previous neck pathology were similarly examined. There were no reports of pain on BPTT in this group. In 36 of the 40 arms a full range of extensibility was present. In the other four arms the loss of extensibility was slight. This study suggests that arm pain and paraesthesiae which follow neck injury in motor vehicle accidents arise from irritable cervical neural tissues. The study also highlights the persistent nature and widespread distribution of the pain in these patients.

Accidents, Traffic↗