TY  - CHAP
M1  - Book, Section
TI  - Neck and Larynx
A1  - Sperry, Jason L.
A1  - Guardiani, Elizabeth
A1  - Snow, Grace
A1  - Meenan, Kirsten
A1  - Feliciano, David V.
A2  - Feliciano, David V.
A2  - Mattox, Kenneth L.
A2  - Moore, Ernest E.
PY  - 2020
T2  - Trauma, 9e
AB  - KEY  POINTSPenetrating  wounds  to  the  neck,  particularly  those  that  might  involve  cervical  vascular  structures,  are  grouped  into  three  separate  vertical  zones  with  different  operative  exposures.In  zone  I,  a  vascular  injury  from  a  penetrating  wound  or  blunt  trauma  may  cause  a  mediastinal  or  extrapleural  hematoma  seen  on  a  chest  x-ray  or  computed  tomography  (CT)  scan  of  the  chest,  external  hemorrhage  from  the  thoracic  outlet,  or  intrapleural  exsanguination.In  zone  II,  a  large  lateral  hematoma  compressing  or  deviating  the  trachea  mandates  endotracheal  intubation  over  a  fiberoptic  bronchoscope;  failure  of  intubation  mandates  a  cricothyroidotomy.In  zone  III,  exsanguinating  hemorrhage  from  the  base  of  the  skull  after  a  penetrating  wound  mandates  insertion  of  a  Fogarty  balloon  catheter  for  rapid  tamponade.When  all  patients  with  penetrating  wounds  through  the  platysma  muscle  in  zone  II  of  the  neck  are  managed  with  a  mandatory  operative  exploration,  nearly  50%  will  have  an  unnecessary  operation.Diagnostic  options  in  patients  with  vascular  “soft”  signs  after  a  penetrating  wound  of  the  neck  are  CT  arteriography  or  duplex  ultrasonography/color  flow  Doppler  in  the  modern  era.A  fracture-dislocation  of  the  cervical  spine  has  a  30%  or  greater  incidence  of  an  associated  blunt  cerebrovascular  injury.Thirty  to  40%  of  patients  with  blunt  injury  to  the  carotid  artery  and  10%  to  15%  of  those  with  blunt  injury  to  the  vertebral  artery  will  suffer  a  stroke  without  treatment.Hyoid  bone  fractures  are  rare,  and  most  can  be  managed  conservatively.Mild  laryngeal  trauma  can  be  managed  with  supportive  care,  whereas  more  severe  trauma  will  require  surgical  intervention.Large  laryngeal  lacerations  with  exposed  cartilage,  disruption  of  the  anterior  commissure,  cartilage  fracture,  injury  to  the  recurrent  laryngeal  nerve,  and  cricotracheal  separation  are  indications  for  operative  repair.Laryngeal  stents  are  used  in  the  presence  of  significant  mucosal  injuries,  injury  to  the  anterior  commissure,  or  when  there  are  multiple  cartilaginous  fracture  lines  that  cannot  be  adequately  stabilized.  
SN  - 
PB  - McGraw Hill
CY  - New York, NY
Y2  - 2024/04/19
UR  - accesssurgery.mhmedical.com/content.aspx?aid=1175133391
ER  -