Penetrating Zone II Neck Injuries

ABSTRACT

The management of penetrating injuries of zone II of the neck presents a difficult problem. The difficulties are due to the close anatomical relationships between the many vital structures in the neck and to the insidious nature in which some of the injuries may present themselves, for example, esophageal lacerations. If a significant injury is overlooked, the consequences may be dire with severe complication and mortality. Two management strategies have been developed for coping with these difficult injuries (1) mandatory exploration of all injuries penetrating the platysma, and (2) a selective approach with neck exploration being performed based on clinical and investigative findings. The aim of this study was to review the clinical characteristics of and the various treatment protocols for II penetrating injuries of the neck. We reviewed retrospectively the medical records of 38 patients who were admitted to and treated at Yongdong Severance Hospital, College of Medicine, Yonsei University, due to penetraing injuries of the neck from Jan. 1990 to Dec. 1996. Twenty-three of the 38 patients (60.5%) underwent immediate operative exploration. In 13 of these patients, the exploration produced positive findings (56.5%), and in 10, the exploration produced negative findings (43.5%). Following neck exploration, 13 patients presenting acutely were found to have 21 injuries. The predominant injuries were vascular followed by neurologic and then respiratory. Eight of the 11 patients (73%) with positive clinical findings were found to have injuries at exploration, and 5 of the 12 patients (42%) with no clinical signs were found to have injuries (p=0.0432). Three of 4 patients (75%) with positive CT scan findings were found to have injuries at exploration and 4 of the 8 patients (50%) with no CT scan findings were found to have injuries (p=0.0455). The complication rate and the performance rate of CT scan were not statistically different between patients with a negative neck exploration and patients with conservative management. The duration of hospitalization was an average of 6.2 days for those patients with a negative neck exploration and 4.1 days for those patients with conservative management (p=0.0022). There was no mortality. In conclusion, it is possible, by careful physical examination and CT scan, it will be possible to reduce the rate of negative neck exploration without risk to those patients who need immediate surgery.