Penetrating aerodigestive injuries in the neck: a proposed CT-aided modified selective management algorithm

Bodanapally, Uttam K.; Shanmuganathan, Kathirkamanathan; Dreizin, David; Stein, Deborah M.; Reddy, Amit K.; Vasquez, Matthew; Cardarelli, Cassandra; Guardiani, Elizabeth

doi:10.1007/s00330-015-4050-3

Cited by 16 publications

(28 citation statements)

References 22 publications

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Section: Resultsmentioning

confidence: 99%

“…We reviewed seven studies (Mazolewski et al, 28 Gracias et al, 29 Gonzalez et al, 30 Inaba et al, 31 , 32 Bodanapally et al, 33 Madsen et al 34 ) that included 877 subjects with PNT who received a CTA (Table 1). Four studies 28,30–32 used a prospective methodology, while three 29,33,34 were retrospective. Inclusion criteria included penetrating injuries (platysma violation of anterior neck) to all three zones of the neck in five studies 29,31–34 and zone II only in two studies 28,30 .…”

Section: Resultsmentioning

confidence: 99%

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Computed tomography angiography for aerodigestive injuries in penetrating neck trauma: A systematic review

Paladino

Baron

Shan

et al. 2021

Academic Emergency Medicine

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Objectives Management of hemodynamically stable patients with penetrating neck trauma (PNT) has evolved in recent years with improvements in imaging technology. Computed tomography angiography (CTA) encompassing all zones of the neck has become part of the standard diagnostic algorithm for PNT patients who do not require immediate surgical intervention for vascular or aerodigestive injuries (ADI). Several studies have demonstrated favorable operating characteristics for CTA at excluding arterial injuries; however, consensus as to CTA’s ability to detect ADI is lacking. We conducted a systematic review (PROSPERO registration number CRD42019133509) to answer the question Is CTA sufficient to rule out ADI in hemodynamically stable PNT patients without hard signs? Methods Investigators independently searched PubMed, EMBASE, and Web of Science from their inception to August 2020 for the search terms “penetrating neck injuries” and “CT scan.” To be included, studies required sufficient data to construct a 2×2 table of CTA for ADI. The operating characteristics of CTA for detecting ADIs are reported as sensitivity, specificity, and likelihood ratios (LRs), with 95% confidence intervals (95% CIs). Bias in our studies was quantified by QUADAS‐2. Results Our search identified 1,242 citations with seven studies with moderate to high risk of bias meeting our inclusion/exclusion criteria and encompassing 877 subjects with an ADI prevalence of 13.4%. CTA for ADI had sensitivity of 92% (95% CI = 85% to 97%), specificity of 88% (95% CI = 85% to 90%), positive likelihood ratio of 12.2 (95% CI = 4.6 to 32), and negative LR of 0.14 (95% CI = 0.05 to 0.37). Of the 26 identified esophageal injuries across our studies that were diagnosed by either swallow studies or surgical exploration, five (19%, 95% CI = 8.1% to 38.3%) were initially missed by CTA. Conclusion CTA alone is not sufficient to exclude esophageal injuries in PNT. Because delayed diagnosis is associated with increased morbidity, additional diagnostic interventions should be undertaken if there is remaining concern for esophageal injury.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Computed tomography angiography for aerodigestive injuries in penetrating neck trauma: A systematic review

Paladino

Baron

Shan

et al. 2021

Academic Emergency Medicine

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“…Aerodigestive tract injury occurs in 5%-7% of patients with penetrating neck injury (15). The upper aerodigestive tract should be assessed for any evidence of breach using both soft tissue and lung windows.…”

Section: Airway and Breathingmentioning

confidence: 99%

“…If the trajectory of the wound breeches either the suprahyoid deep neck spaces or the infrahyoid visceral space (sensitivity ¼ 97%, specificity ¼ 55%), further investigation should take place with either endoscopy or targeted exploration (Fig. 2) (15). In some cases, deep surgical emphysema may be the only clue of a breach of the inner mucosal surface and should prompt further investigation.…”

Section: Airway and Breathingmentioning

confidence: 99%

An approach to accurate computed tomography imaging interpretation in penetrating neck trauma

Adams

Shah

Stephenson

2020

Acta Radiologica Open

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Penetrating neck injury can have potentially devastating consequences due to the many vital structures contained within the neck. In patients who do not require immediate surgery, computed tomography angiography of the neck is the test of choice to characterize the injury. A systematic approach to assessment will ensure a thorough evaluation and give the reporting radiologist the best chance of identifying the significant findings, which can often be subtle. Clear communication with the trauma team at both the time of request and after the imaging has been evaluated to relay any significant findings is vital to ensure the best outcome for the patient.

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“…[1] Penetran boyun travması sonrasında aerodigestif kanalda yaralanma oranı ise %5-7 olarak bildirilmiştir. [2] Boyun travmalarının değerlendirilmesinde boyun üç bölgeye ayrılır: 1. bölge sternal çen-tik-klavikulalar ile krikoid kıkırdak arasındaki; 2. bölge krikoid kıkırdak ile angulus mandibula arasındaki; 3. bölge ise angulus mandibula ile kafa tabanı arasındaki alandır. Birinci ve 3. bölgelere cerrahi yaklaşım kemik yapılar nedeniyle zordur.…”

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Transoral removal of foreign body in a patient with penetrating neck trauma: a case report

Demirhan¹

2017

Kulak Burun Bogaz Ihtis Derg

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ÖZPenetran boyun travması nadir görülen ancak ölümcül de olabilen bir kulak burun boğaz acilidir. Bu yazıda, boynun II. bölgesine penetran travması olan 68 yaşında bir erkek hasta sunuldu. Hastada yutma güçlüğü ve boyun hareketleri ile ağrı vardı fakat hayatı tehdit eden bulgu yoktu. Penetre olan yabancı cisim genel anestezi altında transoral yolla çıkarıldı. Boyun eksplorasyonu yapılmadı ve takipte komplikasyon gözlenmedi. Bu olgu sunumunda, penetran boyun yaralanması olan bir hastadaki alternatif yaklaşımımız sunuldu.Anahtar Sözcükler: Yabancı cisim; hipofarenks; boyun travması; penetran boyun travması; farenks; selektif yaklaşım. ABSTRACTPenetrating neck trauma is a rarely seen ear nose and throat emergency, which may also be fatal. In this article, we report a 68-year-old male patient with penetrating trauma to zone II of the neck. The patient had dysphagia and pain with neck movement but had no life-threatening finding. The penetrating foreign body was removed transorally under general anesthesia. Neck exploration was not performed and no complication was observed in follow-up. In this case report, we presented our alternative approach in a patient with penetrating neck injury.

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Penetrating aerodigestive injuries in the neck: a proposed CT-aided modified selective management algorithm

Cited by 16 publications

References 22 publications

Computed tomography angiography for aerodigestive injuries in penetrating neck trauma: A systematic review

Computed tomography angiography for aerodigestive injuries in penetrating neck trauma: A systematic review

An approach to accurate computed tomography imaging interpretation in penetrating neck trauma

Transoral removal of foreign body in a patient with penetrating neck trauma: a case report

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