Penetrating Neck Trauma in Children: An Urban Hospital's Experience

Abstract

Penetrating neck trauma in children may lead to potentially life-threatening injuries. Selective management of penetrating head and neck injuries in children can be a safe and effective policy in an experienced trauma center.

No. 2 in zone 2: a case report of penetrating neck trauma in a child

“…Low et al found that there was a high incidence of non-correlation between the location of the external injury and damaged internal structures 7. Case in point, our case describes a zone 3 penetrating trauma that, due to the directionality of the penetration, almost compromised zone 2 structures (internal jugular vein, carotid artery, vertebral artery, esophagus, larynx, trachea, thyroid, thoracic duct, and major cervical nerves) 8…”

Dysphagia in a Teenager With Neck Trauma

“…3,14 However, opting for a CT scan in stable pediatric patients with penetrating zone II neck injuries may be an important management option in order to avoid unnecessary surgical exploration. 15,16 The time between perforation and treatment is thought to be crucial, as mortality rates almost double when treatment is delayed by at least 24 hours. 1,4,17 The mainstays of treatment for esophageal perforation are the elimination or prevention of infection with broad spectrum antibiotic therapy, adequate drainage of contaminated sites, appropriate nutritional support, and prompt surgical consultation.…”

“…3,14 However, opting for a CT scan in stable pediatric patients with penetrating zone II neck injuries may be an important management option in order to avoid unnecessary surgical exploration. 15,16…”

“…4,6,11 Primary repair, along with debridement of necrotic tissue, is the treatment of choice in adults with traumatic perforation because it is associated with the lowest mortality rate compared to other approaches. 4,5,16 Moreover, it has been shown to be safe and effective even after a 72-hour delay. 17 Cervical esophageal perforation, unlike thoracic and abdominal perforations, can successfully be treated by drainage alone, although this has not been well studied in major trauma patients.…”

Adding Insult to Injury: Neck Exploration for Penetrating Pediatric Neck Trauma

“…Injuries due to gunshot wounds and stabs have been on the rise in children in urban areas in the United States. 5,6 The neck is a relatively small part of the body, but contains a large number of vital structures; therefore injury in this area can be quite serious. In the period before 1940, most neck injuries were managed with observation, with a mortality rate of 15 to 18 per cent.…”