Penetrating nontorso trauma: the head and the neck

Ball, Chad G.

doi:10.1503/cjs.012814

Cited by 11 publications

(14 citation statements)

References 11 publications

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“…Las lesiones penetrantes del cuello representan alrededor del 5-10% de todos los casos de trauma que se presentan en el Servicio de Urgencias y dan como resultado una mortalidad significativa. [1][2][3] Los componentes cervicales con más frecuencia lesionados en traumatismos penetrantes están relacionados con las lesiones vasculares (21-27%), seguido de la médula espinal (16%) y el tracto aero-digestivo (6-10%), como la laringe o la tráquea y de la faringe o el esófago. 1 Lo más común es que estas lesiones sean secundarias a heridas por arma blanca y de fuego.…”

Section: Antecedentesunclassified

Herida por proyectil de arma de fuego en cuello con lesión traqueoesofágica y colocación de parche muscular de esternotiroideo

Palacios-Zertuche

Montero-Cantú

Guerrero-Hernández

et al. 2016

NCT Neumología Y Cirugía De Tórax

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Este artículo puede ser consultado en versión completa en http://www.medigraphic.com/neumologia RESUMEN. Antecedentes: Las lesiones penetrantes del cuello representan del 5-10% de todos los casos de trauma que se presentan en el Servicio de Urgencias y dan como resultado una mortalidad signifi cativa. Caso clínico: Masculino de 34 años de edad que acudió al Departamento de Urgencias por presentar herida por proyectil de arma de fuego en cuello. Se le realizó intubación endotraqueal y trasladado a quirófano. Por medio de una incisión cervical transversa se observaron lesión esofágica y traqueal a nivel del tercero y cuarto anillo, se colocó cánula de traqueostomía en orifi cio anterior de lesión traqueal, desbridando bordes de lesiones esofágicas y cerrando de forma primaria. Se tomó un colgajo vascularizado de esternotiroideo para colocar parche muscular entre la lesión traqueal y esofágica, dejando drenaje y realizando gastrostomía. Al paciente se le dio alimentación enteral por la gastrostomía, al décimo día se inició vía oral sin datos de fuga. Conclusión: Es imprescindible colocar un colgajo de músculo vascularizado de esternocleidomastoideo o un músculo infrahioideo para proteger la reparación esofágica y reducir la incidencia de fuga y fístula traqueoesofágica. Palabras clave: Lesiones en cuello, lesiones traqueales, lesiones esofágicas, parche muscular. ABSTRACT. Background: Penetrating neck injuries represent 5-10% of all trauma lesions that present to the emergency room resulting in signifi cant mortality. Case report: 34-year-old male is brought to the emergency room with a gunshot wound in the neck. Urgent endotracheal intubation was performed and then referred to the operating room. We performed a transverse cervical incision observing both, esophageal and tracheal lesions comprising the third and fourth tracheal rings. A tracheostomy tube was put in place through the anterior tracheal lesion. Debridement of the borders and primary closure of the esophageal lesion was carried out in order to place a vascularized sternothyroid muscle fl ap between the tracheal and esophageal injuries. A drain is placed and gastrostomy is performed. Enteral nutrition via gastrostomy was indicated for ten days. Oral intake was reinstituted afterwards without evidence of leakage. Conclusion: A vascularized muscle fl ap, involving the sternocleidomastoid or infrahyoid muscles, is critical to protect the esophageal repair and reduce the incidence of tracheoesophageal fi stulas and leakage.

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Section: Antecedentesunclassified

Herida por proyectil de arma de fuego en cuello con lesión traqueoesofágica y colocación de parche muscular de esternotiroideo

Palacios-Zertuche

Montero-Cantú

Guerrero-Hernández

et al. 2016

NCT Neumología Y Cirugía De Tórax

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“…This lack of protection in the neck not only contributes to physician angst during treatment, but also to the high mortality and complication rate when injury occurs [2][3][4]. Airway compromise and exsanguination are both very high priorities and the time required to deal with one can be to the detriment of the other.…”

Section: Introductionmentioning

confidence: 99%

Bridging the Gap: A Novel Method for Hemorrhage Control

Chovanes¹,

Schneider²,

McKee³

et al. 2017

J Health Edu Res Dev

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“…Among these injuries, major arterial lesions are also increasingly infrequent in most developed countries [ 3 ]. However, although rare, they can immediately jeopardize life, mandating prompt diagnosis and repair of the severed arteries and neighboring anatomical structures [ 5 – 7 ].…”

Section: Introductionmentioning

confidence: 99%

“…We present an unusual case report in that the patient presented with an injury to the ECA inside the parotid region with no FN compromise. There is a large consensus in the literature that cases such as this one pose a significant clinical challenge because they involve large and important vascular and/or nerve structures in an emergent scenario [ 7 , 13 , 14 ]. Moreover, clinicians in most centers report limited experience with handling similar cases, which, in turn, causes considerable anxiety in medical personnel [ 7 , 15 ].…”

Section: Introductionmentioning

confidence: 99%

“…There is a large consensus in the literature that cases such as this one pose a significant clinical challenge because they involve large and important vascular and/or nerve structures in an emergent scenario [ 7 , 13 , 14 ]. Moreover, clinicians in most centers report limited experience with handling similar cases, which, in turn, causes considerable anxiety in medical personnel [ 7 , 15 ]. Finally, because these cases are rare, scarce information regarding the surgical anatomy of these wounds is available [ 16 ].…”

Section: Introductionmentioning

confidence: 99%

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Stab injury to the preauricular region with laceration of the external carotid artery without involvement of the facial nerve: a case report

Casal¹,

Pelliccia²,

Pais³

et al. 2017

J Med Case Reports

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BackgroundOpen injuries to the face involving the external carotid artery are uncommon. These injuries are normally associated with laceration of the facial nerve because this nerve is more superficial than the external carotid artery. Hence, external carotid artery lesions are usually associated with facial nerve dysfunction. We present an unusual case report in which the patient had an injury to this artery with no facial nerve compromise.Case presentationA 25-year-old Portuguese man sustained a stab wound injury to his right preauricular region with a broken glass. Immediate profuse bleeding ensued. Provisory tamponade of the wound was achieved at the place of aggression by two off-duty doctors. He was initially transferred to a district hospital, where a large arterial bleeding was observed and a temporary compressive dressing was applied. Subsequently, the patient was transferred to a tertiary hospital. At admission in the emergency room, he presented a pulsating lesion in the right preauricular region and slight weakness in the territory of the inferior buccal branch of the facial nerve. The physical examination suggested an arterial lesion superficial to the facial nerve. However, in the operating theater, a section of the posterior and lateral flanks of the external carotid artery inside the parotid gland was identified. No lesion of the facial nerve was observed, and the external carotid artery was repaired. To better understand the anatomical rationale of this uncommon clinical case, we dissected the preauricular region of six cadavers previously injected with colored latex solutions in the vascular system. A small triangular space between the two main branches of division of the facial nerve in which the external carotid artery was not covered by the facial nerve was observed bilaterally in all cases.ConclusionsThis clinical case illustrates that, in a preauricular wound, the external carotid artery can be injured without facial nerve damage. However, no similar description was found in the reviewed literature, which suggests that this must be a very rare occurrence. According to the dissection study performed, this is due to the existence of a triangular space between the cervicofacial and temporofacial nerve trunks in which the external carotid artery is not covered by the facial nerve or its branches.

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Penetrating nontorso trauma: the head and the neck

Cited by 11 publications

References 11 publications

Herida por proyectil de arma de fuego en cuello con lesión traqueoesofágica y colocación de parche muscular de esternotiroideo

Herida por proyectil de arma de fuego en cuello con lesión traqueoesofágica y colocación de parche muscular de esternotiroideo

Bridging the Gap: A Novel Method for Hemorrhage Control

Stab injury to the preauricular region with laceration of the external carotid artery without involvement of the facial nerve: a case report

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