![]() This zone contains vital structures which include the innominate vessels, the origin of the common carotid artery, the subclavian vessels and the vertebral artery, the brachial plexus, the trachea, the esophagus, the apex of the lung, and the thoracic duct. Zone 1: This is the area between the clavicles and the cricoid cartilage. Understanding the anatomy of the neck, especially the location of important structures, is essential to providing optimal care. Since the zone system is helpful in guiding management decisions, it is preferable to employ the zone system when describing traumatic injuries. In penetrating trauma, zone designations have anatomic, diagnostic, and management implications. įor descriptive and clinical management purposes, the neck is divided into three zones: zones 1, 2, and 3. These structures may pose a diagnostic and therapeutic dilemma in the emergency department. Early referral to the primary team and Anasthesiology team to derive with collective decision is also fundamental in this case.The management of neck trauma can be challenging and sometimes overwhelming, as this anatomical region contains many vital structures. A delay in decision may results in a failed airway and subsequent life threatening condition. It is crucial to monitor the progression of the injury and identify the hard signs as shown in this case. PNI victim may initially present with soft signs of vascular or aerodigestive injury. Patient was extubated after day 3 post trauma. Airway was secured with video laryngoscopy assisted endotracheal intubation in single attempt. The supraglottic structure was edematous with slit like opening. Intraoperative finding shows there was hematoma at the right vallecular extending to lateral pharyngeal wall and right pyriform sinus which was the possible exit wound from the stab injury. Patient was given IV Dexamethasone 8mg and was then brought to Operating Room for elective intubation with neck exploration, direct laryngoscope and esophagoscopy. 5 hour after the injury, patient start to develop dysphonia and hemoptysis which are the hard signs of laryngotracheal injury. Decision was made to proceed with CTA neck and shows extensive subcutaneous emphysema involving the neck extending to deep neck spaces with pneumomediastinum, right submandibular subcutaneous hematoma without the evidence of vascular injury and preserved trachea and esophageal structure. Trial of bedsite flexible scope for airway assessment was suboptimal as patient was uncooperative. ORL and Anasthesiology team was consulted. ![]() Soft tissue Neck Xray shows the presence of subcutenous emphysema over the left side of neck and prevertebral air. ![]() Other primary survey does not show any other life threatening injury. Airway assessment shows evidence of soft signs of vascular and laryngotracheal injury which are hoarseness of voice, subcutaneous emphysema contralateral side to the stab wound of his neck with nonexpanding and nonpulsatile hematoma over the ipsilateral side. He sustained laceration wounds which violates the platysma muscle over his right neck Zone 1 and right submandibular Zone 2. ![]() Penetrating Neck Injury (PNI) pose a challenging decision making in term of either to treat conservatively or operatively.Ī 66 years old man presented to us after being assaulted with a utility knife. ![]()
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