Posterior Penetrating Injury of the Neck: a Case Report

Abstract

SUMMARY – A 45-year-old male patient was admitted to the emergency unit due to posterior stab wound of the neck. The knife was directed diagonally from the left to the right side of the neck in the dorsoventral axis. The patient was fully conscious upon admission with pain and paresthesia along the upper right extremity. The patient underwent computed tomography (CT) and CT angiography scan of the neck, which revealed the knife blade piercing the left sided neck muscles and through the intervertebral ligaments of the C IV/C V in direction to the contralateral internal carotid artery, vertebral artery and the C5 nerve root. The patient underwent an urgent surgery according to the radiographs. Electromyography was performed during the early postoperative care and revealed an acute lesion of the right-sided C5 nerve root. Postoperative follow-up magnetic resonance imaging revealed intact brachial plexus bundles at the site of injury. Symptoms of reduced muscle strength and limited range of motion of the upper right extremity prevailed. Penetrating neck injuries represent a rare entity of all trauma injuries. Meticulous preoperative radiographs revealed close proximity of the knife blade tip to the right-sided vertebral artery and common carotid artery. Limited abduction at the right shoulder during postoperative period correlated to the C5 nerve root injury.

Penetrating vertebral artery injury treated by combining the “zone” approach and imaging tests: A case report

“…Zone I is the area below the cricoid cartilage, Zone II is the area between the cricoid cartilage and the angle of the mandible, and Zone III is the area above the angle of the mandible. 1 , 3 , 4 , 5 The “zone” approach is considered useful because it contributes to better management and improved prognosis. Since Zone II includes the carotid artery, VA, and internal jugular vein, surgeons should exercise caution not to damage these vessels and organs during surgery in this zone.…”

“…Among penetrating neck injuries, carotid artery injury accounts for 6%–17%, internal jugular vein injury accounts for 9%, and VAI accounts for <1% of injuries. 5 , 9 , 10 It is thought that the low proportion of VAI is because the VA runs along the transverse process and is protected by the cervical vertebrae. 1 Furthermore, the anterior aspect of the VA is surrounded by fixed organs (such as the thyroid gland, trachea, and esophagus), muscles, and ligaments.…”

“…For the purpose of evaluating neck injury, the neck is divided into three zones. Zone I is the area below the cricoid cartilage, Zone II is the area between the cricoid cartilage and the angle of the mandible, and Zone III is the area above the angle of the mandible 1,3‐5 . The “zone” approach is considered useful because it contributes to better management and improved prognosis.…”

Medical Approach in Penetrant Cervical Trauma: An Educational View

“…Zone II is the most affected and represents approximately 60% of PCT's, followed by zones I (5% to 31%) and III (1% to 30%). As for the organs with the highest incidence of injuries, there is a disagreement among some authors, with the organs of the respiratory and digestive tracts, followed by injuries to large vessels and nerve injuries, in addition to vascular injuries followed by neurological and aerodigestive tracts (Koruga et al, 2018;Nason et al, 2001;Nwawolo & Asoegwu, 2017) and mortality from penetrating laryngotracheal trauma is reported to be 20%, mortality from pharyngoesophageal injuries reaches 22% (Plott et al, 2007). Unstable cervical spine injuries are rare (Demetriades et al, 1996;Wu et al, 2007).…”

A case report of cervicothoracic penetrating injury with retention of foreign body

“…Penetrating neck injuries are the rarest form among all traumatic injuries at our department [ 1 ]. Neck trauma is a significant surgical emergency faced by ENT surgeons in their clinical practice.…”