Selective management of penetrating neck injuries using “no zone” approach

Prichayudh, Supparerk; Choadrachata-anun, Jirat; Sriussadaporn, Suvit; Pak‐art, Rattaplee; Sriussadaporn, Sukanya; Kritayakirana, Kritaya; Samorn, Pasurachate

doi:10.1016/j.injury.2015.06.019

Cited by 68 publications

(68 citation statements)

References 22 publications

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“…Önceleri platismayı aşan her penetran boyun yaralanmasında boyun eksplorasyonunun zorunlu olduğu kabul edilirken, günümüz-de selektif yaklaşım tercih edilmektedir. [3] Bu olgu sunumunda, farengeal-hipofarengeal lüme-ne ulaşmış yabancı cisme bağlı semptomları olan ancak acil boyun eksplorasyonu endikasyonu olmayan bir hastada transoral yol ile yabancı cismin çıkarılarak boyun eksplorasyonu yapıl-madan selektif yaklaşımın tercih edildiği bir hasta sunuldu.…”

Section: Discussionunclassified

“…İkinci bölgeye yaklaşım ise tartışmalıdır. [3] İkinci Dünya savaşı sırasında edinilen deneyimler sonucu hekimlerin bir kısmı platismayı geçen her yaralanmada zorunlu boyun eksplorasyonu yapılması gerektiğini savunmuş ancak sivil pratikte bu şekilde yapılan boyun eksplorasyonlarının %56'sının tedaviye katkısının olmadığı gösterilmiştir. [4] Bu nedenle [4] Selektif yaklaşımda, yukarıdaki durumların olmadığı hastalarda takip önerilmektedir.…”

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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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Section: Discussionunclassified

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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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“…In addition to routine imaging studies, liberal use of angiography and routine oesophageal evaluation in the form of oesophagoscopy and oesophagography (sensitivity and specificity of almost 100% when used together) was advocated in Zone I injuries owing to the dire consequences of missed injuries in this Zone 3. This led to a non-operative management rate of almost 66%, but a high negative exploration rate of 19% in Zone II injuries 11. Hence, recent studies are advocating eliminating ‘neck zone’ differentiation during triage and management 5.…”

Section: Discussionmentioning

confidence: 99%

Penetrating neck injury from a screwdriver: can the No Zone approach be applied to Zone I injuries?

Bhatt

McMonagle

2015

BMJ Case Reports

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The newer approach to management of penetrating neck injuries (PNI) involves the No Zone approach: comprehensive physical examination combined with CT angiography for triage to effectively identify or exclude vascular and aerodigestive injury. This approach, however, has a low negative exploration rate; there is risk of missing occult injuries especially Zone I and III PNI. We report a case of a patient with PNI to Zone I of the neck who was haemodynamically stable at presentation; CT scan revealed complete occlusion of the common carotid artery. Immediate surgical exploration revealed an occult hypopharyngeal injury in addition to the arterial trauma, which was missed on the CT scan. Hence the No Zone approach needs cautious clinical application, especially in Zone I injuries.

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“…In this study, we followed the no zone approach for the management of PNIs because it was safe and feasible with few negative explorations and no missed injury (9,(35)(36)(37). Also, we avoided routine neck exploration and adopted planned customized surgical intervention according to the expected injuries in each case.…”

Section: Managementmentioning

confidence: 99%

Effectiveness of No-Zone Approach for Management of Isolated Penetrating Neck Injuries Among Hemodynamically Stable Patients. A Longitudinal Retrospective Study.

Hassanein

Hazem

Ahmad

et al. 2020

Preprint

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Background: Routine neck exploration for isolated penetrating neck injuries (PNIs) in hemodynamically stable patients increases the frequency of nontherapeutic surgeries, and complications. Current management protocol involves the no zone approach which uses physical examination and computerized tomographic angiography to guide treatment plans. This work aimed to study the effectiveness and reliability of no-zone approach for management of isolated PNIs in hemodynamically stable patients. Methods: cases of isolated PNIs in hemodynamically stable patients were managed using no zone approach. Detected injuries were managed accordingly. Results: This study included 106 patients. 34.9% of patients were managed conservatively while surgery was done at 65.09%. Vascular management was done in 40.57%, laryngotracheal repair in 29.2%, tracheostomy in 17%, pharyngeal repair in 7.55%, esophageal repair in 6.6%, and accessory nerve repair in 2.83%. Complications occurred in 16.04% of cases in the form of vascular complications (7.5%), respiratory complications (5.7%), pharyngoesophageal complications (1.9%), infections (12.3%), and neurological complications (7.5%). The survivors were 91.5% while deaths were 8.5%. Conclusion: The no-zone approach offers the ideal management for isolated PNIs in hemodynamically stable patients. It is advantageous over traditional approaches. Further studies are required to augment the evidence for its use as the gold standard management for such cases. Trial registration: the study was retrospectively registered at research registry with Research Registry UIN researchregistry5385 on February 26, 2020. Keywords: no zone approach, isolated penetrating neck injuries, hemodynamically stable patients, vascular injuries, laryngotracheal injury.

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Selective management of penetrating neck injuries using “no zone” approach

Cited by 68 publications

References 22 publications

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

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

Penetrating neck injury from a screwdriver: can the No Zone approach be applied to Zone I injuries?

Effectiveness of No-Zone Approach for Management of Isolated Penetrating Neck Injuries Among Hemodynamically Stable Patients. A Longitudinal Retrospective Study.

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