NO ZONE APPROACH FOR MANAGEMENT OF PENETRATING NECK INJURIES-A CASE SERIES

Purpose: The assessment and management of penetrating trauma to the neck has traditionally centered on the anatomical zone based classication over the previous four decades has evolved considerably towards "NO ZONE APPROACH" a more selective option. The purpose of this study was to assess the effectiveness of the “NO ZONE APPROACH” in penetrating neck injuries. Case series of 6 patients with penetrating neck Materials And Methods: injuries admitted in department of general surgery in government Kilpauk medical college and government Royapettah hospital, Chennai. All 6 cases have been analyzed for this descriptive study during a period of 1 year. No specic exclusion criteria applied. All 6 patients survived. 1 patient had nerve injury and external carotid artery injury. 2 patients had Results: tracheal injuries for which tracheostomy was done. 1 patient had avulsed a part of thyroid gland. 1 patient developed cerebrovascular accident post operatively.3 patients had primary repair& neck exploration avoided in those 3 patients by application of NO ZONE APPROACH. Penetrating neck injuries are complex injuries with no single denitive Conclusion: approach. Surgical intervention is mandatory for unstable patients but rapid swift clinical and logical reasoning helps in determining the outcome of the patient. The 'no zone approach' to penetrating neck trauma is a selective approach with superior patient outcomes in comparison with traditional method of zones of neck injuries in which zone 2 and zone 3 warrants denitive exploration. No zone approach mandates thorough clinical examination. Penetrating neck injuries classied as having hard signs based on the no zone approach may be correlated with internal organ injuries of the neck.

Our 12 year experience with Montgomery T-tube in the management of acute blunt laryngotracheal trauma patients / Nossa experiência de 12 anos com o tubo T de Montgomery no tratamento de pacientes com trauma laringotraqueal contuso agudo

Abstract Introduction The Montgomery T-tube is a device used as a combined tracheal stent and tracheostomy tube to prevent post-operative tracheal stenosis. Objectives The purpose of this retrospective study is to evaluate the outcome following Montgomery T-tube stenting performed in for neck and airway injury in patients with acute blunt laryngotracheal trauma over a period of 12 years. Methods Between 2005 and 2017, 19 patients with acute blunt laryngotracheal trauma underwent Montgomery T-tube stenting. All 19 laryngotracheal trauma patients had undergone a preoperative tracheostomy in the emergency department by an ENT surgeon. Montgomery T-tube stenting was done later through an external approach. The follow up period ranged from 2 to 10 years. The Montgomery T-tube was removed after a period ranging from 6 months to 1½ year. Results The majority of patients in the study were in the age group of 21-30 years. A preoperative tracheostomy was done in all 19 patients. All patients except 3 underwent successful decannulation, and experienced long-term satisfactory result. Conclusion Management of acute blunt laryngotracheal trauma is a challenging problem that demands a multidisciplinary approach. The ideal treatment option should be individualized according to the patient's condition and characteristics of injury. According to our study we suggest that cases of acute blunt laryngotracheal trauma patients should be managed following the protocol as mentioned in our study, and we strongly emphasize that Montgomery T-tube should be left for at least 1 complete year in the airway as it results in negligible chances of post-traumatic stenosis of airway later.

Resumo Introdução O tubo T de Montgomery é um dispositivo usado como stent traqueal combinado com tubo de traqueostomia para evitar estenose traqueal pós-operatória. Objetivo Avaliar o resultado do procedimento cirúrgico feito para lesões no pescoço e nas vias aéreas em pacientes com trauma laringotraqueal contuso agudo e o resultado da colocação do tubo T de Montgomery nesses pacientes por 12 anos. Método Entre 2005 e 2017, 19 pacientes com trauma laringotraqueal contuso agudo foram submetidos ao implante do tubo T de Montgomery. Todos os 19 pacientes com trauma laringotraqueal foram submetidos a uma traqueostomia pré-operatória no pronto-socorro por um cirurgião otorrinolaringologista. O implante do tubo T de Montgomery foi feito posteriormente através de uma abordagem externa. O período de seguimento variou de dois a 10 anos. O tubo T de Montgomery foi removido após um período que variou de seis meses a um ano e meio. Resultados A maioria dos pacientes do estudo estava na faixa de 21 a 30 anos. A traqueostomia pré-operatória foi feita em todos os 19 pacientes. Todos, exceto três, tiveram decanulação bem-sucedida e resultado satisfatório em longo prazo. Conclusão O tratamento do trauma laringotraqueal contuso agudo é um desafio que exige uma abordagem multidisciplinar. A opção de tratamento ideal deve ser individualizada de acordo com a condição do paciente e as características da lesão. De acordo com nosso estudo, sugerimos que os casos de pacientes com trauma laringotraqueal contuso agudo sejam tratados de acordo com o protocolo mencionado em nosso estudo e enfatizamos fortemente que o implante do tubo T de Montgomery deve ser mantido por pelo menos um ano completo nas vias aéreas, pois resulta em chances insignificantes de posterior estenose pós-traumática das vias aéreas.

Hipertiroidismo transitorio posterior a trauma cuello en accidente de tránsito Reporte de caso con enfoque Médico Legal / Transient hyperthyroidism after neck trauma in a traffic accident. Case report with a Legal Medical approach

Resumen El hipertiroidismo transitorio posterior a un trauma de cuello es un hecho infrecuente. Se presenta el caso de una femenina de 23 años, quien sufrió un accidente de tránsito presentando trauma en cuello al golpearse con la manivela de una motocicleta, posteriormente presentó supresión de TSH y elevación de T4 circulante, con ultrasonido y TAC que descartaron hematomas o rupturas de la glándula, que luego de manejo conservador presentó normalización de las hormonas tiroideas y evolucionó sin secuelas. Se hizo una revisión de la literatura sobre tiroiditis e hipertiroidismo transitorio post trauma de cuello.

Abstract Transient hyperthyroidism after neck trauma is not common. The case of a 23-year-old female is presented, who suffered a traffic accident presenting trauma to the neck when hitting with the crank of a motorcycle, subsequently presented suppression of TSH and elevation of circulating T4, with ultrasound and CT that ruled out bruises or ruptures of the gland, which after conservative management presented normalization of thyroid hormones and evolved without sequelae. A review of the literature on thyroiditis and transient hyperthyroidism after neck trauma was conducted.

Damage control of laryngotracheal trauma: the golden day / Control de daños del trauma laringotraqueal: todo en 24 horas

Abstract Laryngotracheal trauma is rare but potentially life-threatening as it implies a high risk of compromising airway patency. A consensus on damage control management for laryngotracheal trauma is presented in this article. Tracheal injuries require a primary repair. In the setting of massive destruction, the airway patency must be assured, local hemostasis and control measures should be performed, and definitive management must be deferred. On the other hand, management of laryngeal trauma should be conservative, primary repair should be chosen only if minimal disruption, otherwise, management should be delayed. Definitive management must be carried out, if possible, in the first 24 hours by a multidisciplinary team conformed by trauma and emergency surgery, head and neck surgery, otorhinolaryngology, and chest surgery. Conservative management is proposed as the damage control strategy in laryngotracheal trauma.

Resumen El trauma laringotraqueal es poco frecuente, pero con alto riesgo de comprometer la permeabilidad la vía aérea. El presente artículo presenta el consenso de manejo de control de daños del trauma laringotraqueal. En el manejo de las lesiones de tráquea se debe realizar un reparo primario; y en los casos con una destrucción masiva se debe asegurar la vía aérea, realizar hemostasia local, medidas de control y diferir el manejo definitivo. El manejo del trauma laríngeo debe ser conservador y diferir su manejo, a menos que la lesión sea mínima y se puede optar por un reparo primario. El manejo definitivo se debe realizar durante las primeras 24 hora por un equipo multidisciplinario de los servicios de cirugía de trauma y emergencias, cirugía de cabeza y cuello, otorrinolaringología, y cirugía de tórax. Se propone optar por la estrategia de control de daños en el trauma laringotraqueal.

Forty hours with a traumatic carotid transection: A diagnostic caveat and review of the contemporary management of penetrating neck trauma / 中华创伤杂志(英文版)

Although penetrating neck trauma (PNT) is uncommon, it is associated with the significant morbidity and mortality. The management of PNT has changed significantly over the past 50 years. A radiological assessment now is a vital part of the management with a traditional surgical exploration. A 22 years old male was assaulted by a screwdriver and sustained multiple penetrating neck injuries. A contrast CT scan revealed a focal pseudoaneurysm in the left common carotid artery bulb. There was no active bleeding or any other vascular injuries and the patient remained haemodynamically stable. In view of these findings, he was initially managed conservatively without an open surgical exploration. However, the patient was noted to have an acute drop in his hemoglobin count overnight post injury and the catheter directed angiography showed active bleeding from the pseudoaneurysm. Surgical exploration 40 hours following the initial injury revealed a penetrating injury through both arterial walls of the left carotid bulb which was repaired with a great saphenous vein patch. A percutaneous drain was inserted in the carotid triangle and a course of intravenous antibiotics for five days was commenced. The patient recovered well with no complications and remained asymptomatic at five months followup.

Ruptura traumática de la arteria vertebral por herida penetrante en el cuello / Traumatic rupture of the vertebral artery caused by penetrating neck injury

Introducción: la exanguinación es una entidad clínica dramática que requiere rapidez de pensamiento y acción para obtener buenos resultados.Presentación del caso: se reporta el caso de un paciente de 13 años que sufrió accidente automovilístico y fue atendido en el Hospital Pediátrico Eliseo Noel Camaño , de la provincia de Matanzas, Cuba. El niño llegó con múltiples traumas en miembros superiores e inferiores, y una herida penetrante en el cuello que requirió tratamiento quirúrgico inmediato para controlar hemorragia. Se necesitó un acceso multidisciplinario de intensivistas, anestesiólogos, cirujanos pediátricos, neurocirujanos y cirujanos vasculares, porque la cuantía del sangrado y la localización de la lesión hicieron sospechar una afección traumática de la arteria vertebral. El niño sobrevivió a la lesión exanguinante, y actualmente se encuentra en proceso de recuperación.Conclusiones: la lesión penetrante del cuello puede provocar ruptura traumática de la arteria vertebral, entidad infrecuente que requiere alta sospecha diagnóstica para lograr éxito en su tratamiento. Consideramos vital la visión multidisciplinaria, en la que deben prevalecer maniobras seguras, rápidas y eficientes(AU)

Introduction: exsanguination is a dramatic clinical condition that requires quick analysis and action to achieve good results.Case report: this is a 13 years/old patient who suffered a car accident and was seen at Eliseo Noel Camano pediatric hospital in Matanzas province, Cuba. The teenager had many upper and lower limb traumas and a penetrating neck injury that required immediate surgery to control hemorrhage. It was necessary to involve intensive care experts, anesthesiologists, pediatric surgeons, neurosurgeons, and vascular surgeons because the amount of bleeding and the location of injury aroused the suspicion of traumatic damage of the vertebral artery. The teenager managed to survive from the exsanguinating injury and is currently in his recovery process.Conclusions: the penetrating neck injury may cause traumatic rupture of the vertebral artery, an uncommon condition that requires great diagnostic suspicion in order to succeed in treatment. It is vital to have a multidisciplinary vision in which safe, rapid and effective procedures should prevail(AU)

Vigilance in detecting traumatic blunt neck injuries: A case report

There has been an increase in the number of Motor Vehicle Accidents (MVA) in Malaysia throughout the years. Although blunt neck injury is uncommon, it is associated with severe, permanent neurological deficit with risk of mortality. This case is a classical presentation of a young male involved in a MVA who sustained head and neck injuries of varying severity. After a short symptom free interval, the patient started to develop neurological signs. Presenting signs and symptoms include Horner’s syndrome, dysphasia, hemiparesis, obtundation or monoparesis. A computed tomography (CT) scan of brain must be done and if the findings showed that there is no intracranial bleeding (ICB), high suspicions with further evaluation should be done. Confirmation can be obtained by Doppler ultrasonography, magnetic resonance imaging, magnetic resonance angiography (MRA), CT angiography (CTA) or catheter angiography to rule out carotid artery injury.

Isolated Blunt Lingual Artery Injury Secondary to a Road Traffic Accident: Diagnostic and Therapeutic Approach

Neurologic and airway compromise as a result of traumatic vascular injuries to the neck region often lead to more severe complications and thus require special consideration. Furthermore, these cases pose diagnostic and therapeutic challenges to healthcare providers. Here, we report a case of a 28-year-old motorcyclist presenting with progressively enlarged Zone 2 neck swelling on the left side following a high impact collision. There were no symptoms or signs suggesting neurologic or laryngeal injury. Computed tomography angiogram of the neck revealed signs of an active arterial bleed. The apparent vascular injury was managed by close observation for signs of airway compromise, urgent angiogram, and selective catheter embolisation of the left lingual artery. The patient subsequently recovered without further operative exploration of the neck. At 6 months post-trauma, the neck swelling fully subsided with no complications from angioembolisation. This case illustrates the individualised treatment and multidisciplinary approach in managing such cases. We review our rationale for this diagnostic and therapeutic approach.