Neck Trauma, Penetrating Zone II
Published 2008
Published 2008
No recommendations.
CT angiography or duplex US can be used in lieu of arteriography to rule out an arterial injury in penetrating injuries to zone II of the neck.
CT of the neck (even without CT angiography) can be used to rule out a significant vascular injury if it demonstrates that the trajectory of the penetrating object is remote from vital structures. With injuries in proximity to vascular structures, minor vascular injuries such as intimal flaps may be missed.
No recommendations.
Either contrast esophagography or esophagoscopy can be used to rule out an esophageal perforation that requires operative repair. Diagnostic workup should be expeditious because morbidity increases if repair is delayed by more than 24 hours.
No recommendations.
Selective operative management and mandatory exploration of penetrating injuries to zone II of the neck have equivalent diagnostic accuracy. Therefore, selective management is recommended to minimize unnecessary operations.
High resolution CT angiography offers appropriate diagnostic accuracy with minimal risk, making this the initial diagnostic study of choice when available.
No recommendations.
No recommendations.
No recommendations.
Careful physical examination using protocols for serial examinations, including auscultation of the carotid arteries, is >95% sensitive for detecting arterial and aerodigestive tract injuries that require repair. Given the potential morbidity of missed injuries, clinicians should have a low threshold for obtaining imaging studies.