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 - 2024/10/14 UR - accesssurgery.mhmedical.com/content.aspx?aid=1175133391 ER -