Internal Medicine: Open Access
Open Access

Penetrating Neck Injuries: Treatment and Management

Jigme Ugyen^{* *}Correspondence: Jigme Ugyen, Department of Pharmaceutical Engineering, Gedu College of Business Studies, Gedu, Bhutan, Email:

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About the Study

Penetrating neck trauma is a distinct type of trauma that is becoming more common worldwide that dramatically increases morbidity and mortality. Motor vehicle collisions are most frequently linked to neck injuries. Gunshots, assaults, hangings, shrapnel, and falls are some more mechanisms. Injuries to the neck that penetrate may first seem innocuous based on the appearance of the wound, but since there are so many different essential structures in such a limited anatomical space, there is a considerable risk of underlying organ harm.

Gunshots, stabbings, and other random injuries are the most frequent etiologies of penetrating neck injuries. Different injury patterns and risk variables apply to each category. Gunshot wounds and other high-velocity injuries are more likely to require surgical examination because they do greater damage. The miscellaneous category covers a wide range of injuries caused by many other penetrating objects, from impalement from flying objects to injuries caused by automobile glass as a result of auto accidents as varied and unexpected as the mechanism of damage itself.

Zones I and III are problematic for surgical exposure. Neck injuries that penetrate the skin alone are rare. The most common scenario for penetrating neck injuries is one of numerous traumas. Depending on the structures involved, the presentation may be somewhat asymptomatic or severe and immediately lifethreatening. The search for injuries must be methodical in order to prevent missing delicate results. The history and physical examination should focus on any potential damage sites, such as the oesophagus, larynx, and nervous system.

The most frequent cause of mortality right away following a vascular damage is exsanguination. Mortality from these injuries ranges from 5% to 50%. Morbidity and mortality also ensue from hematomas impairing the airway and direct vascular injury with subsequent occlusion. A vascular injury may have very visible clinical signs, such as pulsatile bleeding or an enlarging hematoma. These symptoms are referred to as "hard signs" since they are thought to show a clear vascular damage. A quick assessment is required since vascular damage may potentially show as modest neurologic or pulse abnormalities. Arteriovenous fistula and traumatic aneurysm are examples of late consequences.

10% of penetrating neck injuries was complicated by laryngotracheal injuries. These wounds are almost never linked with penetrating trauma. Dyspnea, stridor, dysphonia, hemoptysis, laryngeal discomfort, subcutaneous emphysema, and air bubbling from the wound are some of the most typical signs and symptoms. Any of the aforementioned results require a laryngoscopy.

Because of the esophagus's relatively safe location, vascular or laryngotracheal injuries happen less commonly than esophageal injuries. Dyspnea, hemoptysis, and air bubbles through wounds have all been listed as "hard symptoms" of aerodigestive tract injuries. Due to its location, the majority of esophageal injuries are linked to laryngotracheal injuries. Dysphagia, oropharyngeal haemorrhage, nasogastric tube bleeding, subcutaneous emphysema, and resistance to neck movement are all indications of esophageal damage. Crepitance, like laryngotracheal injuries, is a reliable sign of esophageal injury. Despite these indicators, esophageal injuries are the most frequently overlooked neck injury. The fatality rate for these injuries rises with a delay in diagnosis. To stop mediastinitis caused by paraesophageal contamination.

Direct spinal cord damage, cranial nerve damage, peripheral nerve damage, and deficiencies in the central nervous system are all examples of nervous system injuries. With penetrating neck trauma, 10% of patients will also experience spinal cord or brachial plexus injuries. The affected structure and the severity of the injury will determine the clinical appearance. Additionally, because most nerves are situated adjacent to big arteries, the existence of a peripheral nerve damage should inform the evaluating professionals of the potential for an associated artery injury.

Rapid diagnosis and timely treatment are essential for the effective management of penetrating trauma. Without delay, injuries must be found and controlled. There shouldn't be any pointless inquiries or interventions. When it comes to penetrating trauma versus blunt trauma, clinical examination is generally more reliable. Without the requirement for radiographic or other assessments, the clinical evaluation of many damage patterns can be completed. In order to guide the correct investigation to the right patient at the right time, clinical assessment is essential to this procedure. Today, many ailments can be treated completely without surgery. This reduces the risks associated with surgery and anaesthesia and boosts hospital productivity. Decision-making prioritizes the presence of clinical symptoms and indicators over platysmal muscle penetration.