PENETRATING TRAUMA IN THE NECK: REVIEW OF 16 OPERATED CASES

Abstract

Background: Cervical lesions from penetrating trauma in the neck are increasing together with other types of trauma especially in big towns. Nevertheless in Italy a Register of Trauma is still lacking and no guide lines are available. Conservative management is also advocated and is still under discussion. Comparison of diagnostic tools and evaluation of different treatments in case of vascular damage is also expected.

Patients and methods: A series of 16 penetrating lesions of the neck including various degrees of severity were treated over a span of 5 year. The penetrating trauma was due to stab wound or similar causes in 11 cases, to gunshot wound in 3 and to route accidents in 2 cases. All of them received surgical treatment. In 56% of cases (9/16) of cases vascular structures were involved, in 4 cases the aerodigestive tract was involved (25%), and in 1 the spinal cord was injured (6%) resulting in a Brown-Sequard syndrome. Other patients presented with superficial lesions , and reconstruction of muscles by simple suture or ligature of veins could obtain complete healing.

Results: The penetrating trauma brought about death in 2 cases (1 stab wound, 1 gunshot wound), while 1 lesion of carotid artery and 4 lesions of jugular vein were successfully repaired. In 1 case of lesion in zone 3 a serious bleeding from damage to lingual artery was cured in spite of the minimal width of the external injury. Hypofaringeal lesions could be treated in 2 cases, because 1 was associated with lethal vascular damage. In 1 case of tracheal lesion with cervical hematoma and dyspnea patency of the airways became the main concern and and a cannula was placed in the trachea. The Brown-Séquard syndrome could improve with rehabilitation therapy in 3 years. All of the minimal cervical lesions healed with uneventful course.

Conclusions: The penetrating trauma in the neck may show various degrees of severity: nevertheless, no cervical penetrating trauma should be underestimated in spite of the minimal width of the lesion. Surgical exploration was invariably the preferred treatment in our experience. When the lesion was deeper in the neck surgical exploration and operation required higher competence and anatomical knowledge to perform a correct treatment in such a dramatic circumstance like emergency. Anatomical division of neck in 3 zones was helpful for the Team Leader Surgeon, and collaboration with Intensive Care Specialists and other specialists was essential to face such situations.