Physical examination alone is safe and accurate for evaluation of vascular injuries in penetrating zone II neck trauma. 63. Apffelstaedt JP, Müller R. Results of mandatory exploration for penetrating neck trauma. It is important to note that some trauma centers have moved away from using the âzonesâ in penetrating neck trauma, and have instead used a zone free or âno-zoneâ approach with using CTA of the neck as first line diagnostic imaging. Management of penetrating trauma to the neck. Figure 13.1 Zones of the neck as defined for purposes of trauma Zone II extends from the angle of the mandible superiorly to the cricoid cartilage inferiorly. 107. Role of angiography in cervicothoracic trauma. Due to the large number of critical structures in the neck, a clear knowledge of the anatomy is ⦠Atteberry LR, Dennis JW, Menawat SS, et al. Vascular injury is the most common complication of penetrating neck trauma, occurring in 25%, with mortality of nearly 50%. The neck trauma zones are illustrated. 2013;15(0):1-5. 1998 Feb;16(1):45-61 PMID: 9496314. McConnell DB, Trunkey DD. Background: Patients with penetrating neck trauma can present with a variety of injury patterns including hemorrhagic shock, airway obstruction and neurologic injury. Trauma. Thomas AN, Goodman PC, Roon AJ. O'Donnell VA, Atik M, Pick RA. Stable penetrating neck trauma patients, regardless of zone, should first undergo CTA. J Am Coll Surg. What matters is how your patient is doing. CJEM. 1978;76:633-638. 5. 3. Injuries to this zone that penetrate the platysma generally warrant exploration, and prompt surgery is required in unstable patients. This shows a lateral view of the 3 anatomic zones of the neck. STN E-Library 2012 14 8_Neck Trauma. Anatomically, the neck is sectioned out by regions, or zones. In fact, the zones donât really matter. Please use the practice that is standard at your trauma center. Asensio, JA Valenziano CP, Falcone RE, Grosh JD. Zone II, between Zones I and III, is the area of controversy. STN E-Library 2012 15 8_Neck Trauma ⢠Zone 1 extends from the base of the neck ⦠Penetrating zone-II neck injuries in children. Management of penetrating neck injuries. 4. Youssef N, Raymer KE. From the case: Neck trauma injury zones (diagram) Diagram. Airway management of an open penetrating neck injury. 1994;179:657â662. Zone I, including the thoracic inlet, up to the level of the cricothyroid membrane, is treated as an upper thoracic injury. Serious injuries may not be clinically obvious making diagnosis and prompt treatment challenging. Zone 2 injuries are the most common, followed by Zone 1, and then Zone 3 1. Of note, there is a concept of âNo Zoneâ. Evaluation and management of penetrating wounds of the neck: the role of Management of the difficult airway in the trauma patient. J Trauma.1991;31:1614-1617. FOAM and web resources. I know what zone the neck injury is inâ¦now what? PubMed PMID: 24192521. 62. Scan Can Be Used for Surgical Decision Making in Zone 2 Penetrating Neck Injuries.The Journal of Trauma. J Thorac Cardiovasc Surg. example, injuries in Zone 3 are markedly different than those in Zone 1. Zone III, above the angle of the mandible, is treated as a head injury. Emerg Med Clin North Am. World J Surg1994; 18:917. 2001; 51: 315-319 ⢠14 stable patients with zone II injuries ⢠PE, CT scan & operative exploration performed ⢠CT scan = high /low probability for injury ⢠Surgical findings compared with preoperative CT Penetrating Neck Trauma 2,3,6 This aides in trauma injury evaluation. Adv Surg 1994; 27:97. Walls RM. 2 . The neck has been decided into threes zones. As a recap: Trauma to the neck is bad. There are 3 zones (see previous neck trauma post).
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