Imaging assessment of penetrating injury of the neck and face

Abstract

BackgroundPenetrating trauma of the neck and face is a frequent presentation to acute emergency, trauma and critical care units. There remains a steady incidence of both gunshot penetrating injury to the neck and face as well as non-missile penetrating injury—largely, but not solely, knife-related. Optimal imaging assessment of such injuries therefore remains an on-going requirement of the general and specialised radiologist.MethodsThe anatomy of the neck and face—in particular, vascular, pharyngo-oesophageal, laryngo-tracheal and neural anatomy—demands a more specialised and selective management plan which incorporates specific imaging techniques.ResultsThe current treatment protocol of injuries of the neck and face has seen a radical shift away from expectant surgical exploration in the management of such injuries, largely as a result of advances in the diagnostic capabilities of multi-detector computed tomography angiography (MDCTA), which is now the first-line imaging modality of choice in such cases.ConclusionThis review aims to highlight ballistic considerations, differing imaging modalities, including MDCTA, that might be utilised to assist in the accurate assessment of these injuries as well as the specific radiological features and patterns of specific organ-system injuries that should be considered and communicated to surgical and critical care teams.Teaching points• MDCTA is the first-line imaging modality in penetrating trauma of the neck and, often, of the face• The inherent deformability of a bullet is a significant factor in its tissue-damaging capabilities• MDCTA can provide accurate assessment of visceral injury of the neck as well as vascular injury• Penetrating facial trauma warrants radiological assessment of key adjacent anatomical structures• In-driven fragments of native bone potentiate tissue damage in projectile penetrating facial trauma

Western Trauma Association Critical Decisions in Trauma

“…It has been demonstrated that contrast swallow studies are less sensitive in detecting hypopharyngeal injuries as compared with esophageal injury and flexible nasoendoscopy or video endoscopy should be part of the ''trauma surgeon's armamentarium.'' 51,53 …”

An Unusual Pediatric Case of Allen Key Penetrating Trauma in Maxillofacial Region

“…Patients coming in the emergency with blast injuries and penetrating trauma should undergo radiological investigation before operation. Waters and lateral skull views are useful imaging tools in diagnosing FB and CT scan can be usefully used to evaluate the presence and exact location of FB [8, 13, 14]. …”

Cervical spondylodiscitis with epidural abscess after knife stab wounds to the neck: A case report

“…A CT-scan could decrease the likelihood of a negative neck exploration [13,14]. Nevertheless, Gonzalez et al [15] showed in a prospective study that not all vessel injuries and esophageal injuries due to penetrating zone II injuries could be detected using a dynamic CT-scan or esophagography.…”