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Journal articles on the topic 'Neck – Wounds and injuries'
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1
Low, Garren M. I., Kenji Inaba, Konstantinos Chouliaras, Bernardino Branco, Lydia Lam, Elizabeth Benjamin, Jay Menaker, and Demetrios Demetriades. "The Use of the Anatomic ‘Zones’ of the Neck in the Assessment of Penetrating Neck Injury." American Surgeon 80, no. 10 (October 2014): 970–74. http://dx.doi.org/10.1177/000313481408001013.
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The traditional classification of neck injuries uses an anatomic description of Zones I through III. The objective of this article was to characterize the association between external wounds and the corresponding internal injuries after penetrating neck trauma to identify the clinical use of the anatomic zones of the neck. Patients who sustained penetrating neck trauma from December 2008 to March 2011 were analyzed. All patients underwent structured clinical examination documenting the external zone where the wound(s) were located. All internal injuries were then correlated with the external wounds. An internal injury was defined as “unexpected” if it was located outside the borders of the neck zone corresponding to the external wound. In total, 146 patients sustaining a penetrating neck injury were analyzed; 126 (86%) male. The mechanism of injury was stab wounds in 74 (51%) and gunshot wounds in 69 (47%). Mean age was 31 years (range, nine to 62 years). Thirty-seven (25%) patients sustained had a total of 50 internal injuries. There was a high incidence of noncorrelation between the location of the external injury and the internal structures that were damaged in patients with hard signs of vascular or aerodigestive injury. The use of the anatomic zones and their role in the workup of penetrating neck injury are questionable.
2
Sizyi, M. Yu. "Septic complications in patients with neck wounds." Експериментальна і клінічна медицина 84, no. 3 (August 21, 2020): 64–66. http://dx.doi.org/10.35339/ekm.2019.84.03.10.
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Nowadays, we have been a steady increase in injuries as the social conditions of life and have changed. Statistically found that 54.0 % of people of car accidents have injuries to the head and neck. According to the literature, mortality in patients with neck injury which is complicating by pyoinflammatory persists up to 30.0-76.0 %. The management of neck trauma can be challenging and sometimes overwhelming, as this anatomical region contains many vital structures. These structures may pose a diagnostic and therapeutic dilemma. Our research based on the results of diagnosis and treatment of 124 patients with a purulent mediastinitis, complicating traumatic injuries of the neck organs. Among these men – 92 (74.2 %), women – 32 (25.8 %). The results of treatment depend on timely diagnosis, hospitalization in a specialized compartment and conducting active surgical tactics
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Madsen, AS, GL Laing, JL Bruce, and DL Clarke. "A comparative audit of gunshot wounds and stab wounds to the neck in a South African metropolitan trauma service." Annals of The Royal College of Surgeons of England 98, no. 7 (September 2016): 488–95. http://dx.doi.org/10.1308/rcsann.2016.0181.
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Introduction The aim of this comparative study of gunshot wounds (GSWs) and stab wounds (SWs) to the neck was to quantify the impact of the mechanism of injury on the outcome and management of penetrating neck injury (PNI). Methods A prospective trauma registry was interrogated retrospectively. Data were analysed pertaining to demographics and injury severity score (ISS), physiology on presentation, anatomical site of wounds and injuries sustained, investigations, management, outcome and complications. Results There were 452 SW and 58 GSW cases over the 46 months of the study. Patients with GSWs were more likely to have extracervical injuries than those with SWs (69% vs 63%). The incidence of a ‘significant cervical injury’ was almost twice as high in the GSW cohort (55% vs 31%). For patients with transcervical GSWs, this increased to 80%. The mean ISS was 17 for GSW and 11 for SW patients. Those in the GSW cohort presented with threatened airways and a requirement for an emergency airway three times as often as patients with SWs (24% vs 7% and 14% vs 5% respectively). The incidence among GSW and SW patients respectively was 5% and 6% for airway injuries, 12% and 8% for injuries to the digestive tract, 21% and 16% for vascular injuries, 59% and 10% for associated cervical injuries, 36% and 14% for maxillofacial injuries, 16% and 9% for injuries to the head, and 35% and 45% for injuries to the chest. In the GSW group, 91% underwent computed tomography angiography (CTA), with 23% of these being positive for a vascular injury. For SWs, 74% of patients underwent CTA, with 17% positive for a vascular injury. Slightly more patients with GSWs required operative intervention than those with SWs (29% vs 26%). Conclusions Patients with GSWs to the neck have a worse outcome than those with injuries secondary to SWs. However, the proportion of neck injuries actually requiring direct surgical intervention is not increased and most cases with PNI secondary to GSWs can be managed conservatively with a good outcome. Imaging should be performed for all GSWs to the neck.
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Yetiser, Sertac, and Mustafa Kahramanyol. "High-Velocity Gunshot Wounds to the Head and Neck: A Review of Wound Ballistics." Military Medicine 163, no. 5 (May 1, 1998): 346–51. http://dx.doi.org/10.1093/milmed/163.5.346.
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Abstract Patients who sustain gunshot injuries to the head and neck face heavy tissue damage and eventually life-threatening conditions. A very significant factor that determines the degree of injury is the course and extent of the missile track. The missile track is well correlated with bullet structure, size, and velocity, which have distinct features in civilian and military firearm injuries. The missile entrance or exit wound may be out of sight in some injuries, and often it is difficult to predict the severity of the injury in the chaotic circumstances of the battlefield. We studied the wound ballistics in five soldiers who suffered penetrating cranial and cervical firearm injuries.
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Swain, Rajanikanta, Shivani Dhaka, Munish Sharma, Mantaran Singh Bakshi, OP Murty, and Asit Kumar Sikary. "Accidental cut-throat injuries from the broken windshield of an auto rickshaw: Two unusual cases." Medicine, Science and the Law 58, no. 3 (April 22, 2018): 183–85. http://dx.doi.org/10.1177/0025802418768320.
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Accidental cut-throat injuries are extremely rare and usually involve a sharp-edged weapon. In this paper, two cases of a cut-throat wound to two auto-rickshaw drivers are presented where the broken windshield of the auto-rickshaws was responsible for the wounds. In both the cases, fatal incised wounds were present over the neck, cutting the soft tissue along with the major vessels. The death occurred due to exsanguination caused by neck-vessel injury in one case and trachea along with neck-vessel injury in the second case. Although the wounds on the neck initially suggested homicide, they were found to have occurred accidentally as a result of a road traffic accident involving a head-on collision of auto rickshaws. The injuries were inflicted by the shattered glass of the windshield.
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Syzyi, M. Yu. "TREATMENT-DIAGNOSTIC MEASURES FOR INJURY OF THE NECK." Kharkiv Surgical School, no. 3-4 (December 20, 2019): 123–25. http://dx.doi.org/10.37699/2308-7005.3-4.2019.28.
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Summary. The article is devoted to the study of the urgent problem of neck injury and medical diagnostic tactics. Externally, a small wound on the neck can hide serious damage to deep structures and adjacent anatomical areas. In peacetime during neck injuries, it is necessary stick to the basic principles of surgery: all wounds are subject to primary surgical treatment with a thorough revision of the wound canal. The algorithm of therapeutic and diagnostic measures depends on the nature and severity of the damage, clinical symptoms, and related injuries that are life-threatening.
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Tkachenko, Pavlo I., Serhii O. Bilokon, Olha B. Dolenko, Nataliia M. Korotych, Yuliia V. Popelo, and Nataliia P. Bilokon. "BITTEN WOUNDS OF THE MAXILLOFACIAL AREA IN CHILDREN." Wiadomości Lekarskie 73, no. 6 (2020): 1108–13. http://dx.doi.org/10.36740/wlek202006105.
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The aim of the work is to determine the frequency, structure, features of clinical manifestations and treatment of bitten wounds of the face and neck in children of Poltava region. Materials and methods: It has been analyzed 91 histories of disease of thematic patients undergone treatment at the Surgical Department of Pediatric town clinical hospital of Poltava. Results: In the structure of traumatic injuries of maxillofacial area in children 5.3% were patients with bitten wounds of the face and neck. Among the injured were children of the age 7-12 years old (30.2%). In 74.7% of cases, the bites were complicated by acute inflammatory processes. Urban residents accounted for 71.8% of the total number of cases, while rural residents accounted for 28.2%. Boys were injured by 53.6% and girls by 46.4%. Sharps (74.5%), punctures (19.3%) and lacerations (6.2%) differed in form. The comprehensive treatment of patients with bitten maxillofacial area wounds was carried out according to the protocol of care. Conclusions: The clinical picture and severity of bitten wounds of maxillofacial area in children have individual features, which are largely due to topographic and anatomical localization of injuries. The choice of the optimal variant of primary surgical treatment of wounds and the amount of surgery should be determined individually depending on the severity of the injury, the time of injury. Special attention should be paid to normalization of psycho-emotional state of patients and prevention of scar formation.
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Vassiliu, Pantelis, Jay Baker, Shawn Henderson, Kathy Alo, George Velmahos, and Demetrios Demetriades. "Aerodigestive Injuries of the Neck." American Surgeon 67, no. 1 (January 2001): 75–79. http://dx.doi.org/10.1177/000313480106700117.
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Cervical aerodigestive trauma is rare and most centers have a limited experience with its management. The purpose of this review was to study the epidemiology, diagnosis, and problems related to the early evaluation and management of these injuries. This was a retrospective study based on trauma registry and on chart, operative, radiological, and endoscopic reports. There were 1560 admissions with blunt or penetrating trauma to the neck. The overall incidence of aerodigestive trauma was 4.9 per cent (10.2% for gunshot wounds, 4.6% for stab wounds, and 1.2% for blunt trauma). All patients with aerodigestive trauma had suspicious signs or symptoms on admission. The most common life-threatening problem in the emergency room and directly related to the aerodigestive trauma was airway compromise. Twenty-nine per cent of patients with laryngotracheal trauma required an emergency room airway establishment because of threatened airway loss. Although rapid sequence induction was successful in the majority of cases, in 11.9 per cent there was loss of airway and a cricothyroidotomy was necessary. Overall, 9 per cent of cases with aerodigestive injuries were successfully treated nonoperatively. Thirty-six per cent of patients with laryngotracheal trauma and surgical repair were successfully treated without a protective tracheostomy. There was no mortality due to the aerodigestive injuries. Cervical aerodigestive trauma is rare. In conclusion, all patients with significant aerodigestive injuries requiring treatment had suspicious signs and symptoms. Airway compromise was a common problem in the emergency room. Loss of airway after rapid sequence induction is a potentially lethal complication and the trauma team should be ready for a surgical airway. Repair of laryngotracheal injuries without a protective tracheostomy is safe in selected cases.
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Lee, Dennis, Michael Nash, Jon Turk, and Gady Har-El. "Low-Velocity Gunshot Wounds to the Paranasal Sinuses." Otolaryngology–Head and Neck Surgery 116, no. 3 (March 1997): 372–78. http://dx.doi.org/10.1016/s0194-59989770276-6.
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There are more than 200 million private firearms in the United States today. Firearm-associated deaths are the second leading cause of mortality for men 1 to 38 years of age. There are many studies in the literature concerning the management of high-velocity gunshot injuries to the head and neck. However, there are no studies in the English language literature concerning the management of isolated low-velocity gunshot wounds to the paranasal sinuses. We retrospectively reviewed 35 patients treated for low-velocity gunshot wounds of the paranasal sinuses between 1985 and 1994 at Kings County Hospital Center. The injuries sustained by these patients were less severe than previously reported for high-velocity missile or shotgun injuries. The management of these injuries is outlined with emphasis on (1) indications for angiographic studies, (2) airway management, and (3) indications for operative removal of bullet fragments.
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Piccart, Frederik, JakobTitiaan Dormaar, Ruxandra Coropciuc, Joseph Schoenaers, Michel Bila, and Constantinus Politis. "Dog Bite Injuries in the Head and Neck Region: A 20-Year Review." Craniomaxillofacial Trauma & Reconstruction 12, no. 3 (September 2019): 199–204. http://dx.doi.org/10.1055/s-0038-1660441.
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Dog bite-related wounds seem to have become a common problem, especially when they relate to the head and neck region. According to Overall and Love, up to 18 per 1,000 people sustain a dog bite every year, of whom 3 need medical attention. Approximately 1 to 2% of bite injuries require hospitalization of the victims. Most of the lacerations are found in the upper lip and the nose regions and they are classified according to severity and concomitant damage to other organs. Bite wounds are considered “dirty” wounds and are prone to infection. When dealing with bite wounds, there is always an indication for antibiotic treatment. Broad-spectrum antibiotics like amoxicillin-clavulanate and/or moxifloxacin cover most of the pathogenic flora and should be administered in every bite wound case at risk of infection. This article would like to present a medical record review: a retrospective analysis of all bite wounds sustained in the head and neck region, treated at the University Hospital of Leuven over the past 20 years. Furthermore, it provides an overview of the current literature and its standings on the treatment of dog bite injuries in the maxillofacial region. We assessed both surgical and medical treatment options, as well as primary management, which includes infection prevention strategies, closure management, and additional vaccination requirements. Secondary management or scar revision methods will be mentioned. After conducting a UZ Leuven database search using keywords such as “dog,” “dog bite,” “face,” “head,” “lip,” and others, 223 patients were included. Age at the time of injury, location of the injury, treatment method used, and whether secondary infection was present or not were documented. All patients have been divided in age groups. We concluded that 21.52% was 5 years old or younger. Almost half of our patients (49.33%) were 18 years old or younger. Of all patients, 79 were hospitalized (35.43%). Primary closure was the treatment of choice. In 141 patients, the wounds were closed primarily (63.23%), resulting in only 2.24% reported secondary infections. Only one fatality was reported in our center over the course of 20 years (0.45%), a 6-year-old girl who had been attacked by her father's Rottweilers. Most patients who sustained dog bite injuries in the head and neck region seem to be children, specifically toddlers. Due to their height, it is possible they are more prone to dog bite injuries in the head and neck region. It is essential to optimize management of these injuries due to the impact they have on patients. This article provides the epidemiological data and clinical outcome of the approach at our center.
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Syzyi, M. Yu. "URGICAL TACTICS IN WOUNDS OF PHARYNX AND CERVICAL ESOPHAGUS." Kharkiv Surgical School, no. 5-6 (December 25, 2019): 95–98. http://dx.doi.org/10.37699/2308-7005.5-6.2019.20.
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Summary. The results of surgical treatment of 98 patients with penetrating injuries to the pharynx and cervical esophagus are presented. The patients were divided into the main and the comparison group. In the comparison group, the traditional principles of intervention were used. In the main group, surgical intervention was performed with a mini access on the neck 3-4 cm in length using a ring-shaped retractor. In the main group there was a twofold decrease in the frequency of purulent complications after surgical treatment of penetrating injuries to the pharynx and cervical esophagus, in comparison with the comparison group.
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Kozachenko, Ihor. "Nonfatal air gun shot trauma: structural analysis and morphological features injuries." Forensic-medical examination, no. 2 (December 30, 2016): 47–51. http://dx.doi.org/10.24061/2707-8728.2.2016.10.
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In practical activities of the Ukrainian bureau of forensic we increasingly come across cases of nonfatal air gun injuries. However, experts lack a common methodological approaches for forensic evaluation of injuries, particularly during the examination of living people. An earlier analysis of nonfatal air gun injuries made on materials of only two regional bureau of forensic medical examination, a purely local nature used on a small number of cases using some general parameters can provide processing methodology study of air gun injuries and practical recommendations for the implementation of forensic medical examinations. 127 cases of «Expert’s conclusions» and «Acts of the forensic examination» were investigated, taken from 21 bureaus all regions of Ukraine during the period of 2006-2015, in which was performed forensic medical examinations in cases nonfatal air guns injuries.Discussion. The main causes of nonfatal air gun injuries are named as hooliganism, domestic conflicts, careless handling of weapons and robbery. Among the injured men is 86 %, women – 14 %. Injuries made mostly of air pistols and rifles, caliber 4.5mm. Among the weapons 8 models applied rifles large and extra large capacity. Most commonlywounded parts were head (38 %), chest (17,3 %) and lower limbs (16 %), less common – upper limbs (10,2 %) and neck (3,9 %). Input air gun injuries are mainly wounds (74 %), sometimes abrasions (23 %) and bruising (3 %). The nature and volume air gun injuries primarily dependent on the power of the applied weapon and the affected areas of the body, penetrating wounds from shots of powerful guns are accompanied by injuries of the brain and spinal cord, internal organsof the chest and abdomen bleedings, fractures of the skull, vertebrae, ribs and scapula; of shots from pistols and rifles low penetrating injuries were observed only in the cranial cavity, mostly after bullet passing an eyeball.Conclusions:1. The main causes of nonfatal air gun shot trauma were hooliganism, domestic violence, accidents and robberies. Among the casualties men is 86 %, women – 14 %.2. Injuries made mostly of air pistols and rifles, caliber 4.5mm including extra large power rifles.3. Most cases provided head, chest and lower limbs wounds, fewer cases of upper limbs and neck injuries were observed.4. High and extra large power rifles more caused penetrating air gunshot wounds of major body cavities with injury to the brain and spinal cord, internal organs with hemorrhages and bone fractures. Pistols and low power rifles caused penetrating injuries only in the cranial cavity, commonly after passing projectile eyeball.5. The majority of wounds are defined as minor injuries. Injuries of moderate severity made up only 2%. Serious injuries attributed to 13% according hazard to life and complete loss of sight.
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Stierman, Karen L., Kristen M. Lloyd, Danielle M. De Luca-Pytell, Linda G. Phillips, and Karen H. Calhoun. "Treatment and Outcome of Human Bites in the Head and Neck." Otolaryngology–Head and Neck Surgery 128, no. 6 (June 2003): 795–801. http://dx.doi.org/10.1016/s0194-59980300254-7.
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OBJECTIVE: Our goal was to review head and neck human bite injuries for demographic, treatment, and outcome data to identify factors influencing infection. STUDY DESIGN: Retrospective chart review of all human bite injuries (adult and pediatric) over 10 years. SETTING: Tertiary referral medical center. RESULTS: We reviewed 40 human bites (average follow-up, 139 days). Young males were the most common victims, altercation was the most common etiology, and auricular avulsion was the most common injury. Six wounds closed primarily became infected (40%) versus no wound infection with delayed closure. Primary wound closure ( P < .01), exposed cartilage ( P < .07), and less than 48 hours of intravenous antibiotics ( P < .06) were associated with postoperative infection ( P < .01). CONCLUSION: Human bites to the head and neck, especially those with exposed cartilage, are best treated with at least 48 hours of intravenous antibiotics and delayed surgical closure (>24 hours postinjury) to prevent infection. SIGNIFICANCE: This information enables the clinician who sees these bite wounds infrequently to understand the treatment associated with avoiding infection.
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Tariq, M., A. Kalan, S. S. Surenthiran, and A. Bhowmik. "Penetrating neck injury: case report and evaluation of management." Journal of Laryngology & Otology 114, no. 7 (July 2000): 554–56. http://dx.doi.org/10.1258/0022215001906165.
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Greater urban violence has resulted in an increased incidence of penetrating neck trauma. Penetrating neck wounds can present difficult diagnostic and therapeutic dilemmas. The evaluation and management of such injuries, however, remains controversial. There is no universally accepted specific approach to the management of patients with penetrating neck injuries, with some surgeons advocating mandatory neck exploration whilst others believe in selective surgical intervention.We believe that an equal willingness for both conservative and surgical intervention as dictated by serial bedside evaluation with adequate radiological and endoscopic support can provide the clinician a safe and effective means of managing a potentially complex and lethal problem.
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Kountakis, Stilianos E., Socorro A. Chamblee, Alberto A. J. Maillard, and Charles M. Stiernberg. "Animal Bites to the Head and Neck." Ear, Nose & Throat Journal 77, no. 3 (March 1998): 216–20. http://dx.doi.org/10.1177/014556139807700312.
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There is controversy regarding the timing of repair and the use of prophylactic antibiotics in patients with animal bites to the head and neck. In this paper we review our experience with such wounds, and address surgical management and the use of prophylactic antibiotic therapy. A retrospective review of the medical records of 29 patients with animal bites to the head and neck was conducted. All patients were seen and treated at a large teaching hospital in Houston, Texas over an 18-month period. Seventy-six percent of our patients were 12 years old or younger. Most came to the emergency room soon after sustaining their injuries, and their wounds were repaired primarily with favorable results. There were no cases of wound infection. Ninety percent were treated with prophylactic antibiotics. The wounds of the 10% of patients who did receive antibiotics were similar to those of the other patients and healed well without infection. Wounds resulting from animal bites to the head and neck can be repaired primarily when treated shortly after injury. Further prospective, randomized studies are recommended to evaluate the effectiveness and necessity of prophylactic antibiotic therapy in this patient population.
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Das, Sauradeep, Jijitha Lakshmanan, Arun Alexander, and Rashmi Hansdah. "Undiagnosed pharyngeal perforation following a penetrating neck trauma in a 5-year-old child: a proposed treatment algorithm." BMJ Case Reports 14, no. 9 (September 2021): e244098. http://dx.doi.org/10.1136/bcr-2021-244098.
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External penetrating wounds of the neck leading to pharyngeal perforations are relatively uncommon. The small area of the neck contains the vital vascular, aerodigestive and nervous structures, which are difficult to access surgically. Pharyngeal perforations are challenging to treat, especially in children, as primary wound inspection may be difficult, leading to life-threatening complications like retropharyngeal abscesses, mediastinitis or airway compromise. The following is a case report of a 5-year-old girl who had a road traffic accident causing a neck laceration with a pharyngeal tear, which was only identified during emergency neck exploration in the operating room. A review of known literature and a proposed algorithm for managing penetrating neck injuries with pharyngeal injury is described.
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Martins Farinha, Pedro, and Diogo Lino Moura. "Biomecânica e Traumatologia do Boxe." Revista de Medicina Desportiva Informa 12, no. 6 (November 1, 2021): 10–12. http://dx.doi.org/10.23911/biomecan_boxe_2021_nov.
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Amateur boxing practiced at the Olympic Games has been evolving in conditions of safety for its athletes. The most common injuries are head wounds and lacerations, brain concussions and fractures. However, professional boxing has not kept up with this trend of revising rules and promoting greater safety, turning their athletes prone to severe injuries, especially head and neck injuries. The knowledge of epidemiology and biomechanics of boxing injuries may allow athletes and coaches to anticipate injuries and adopt effective prevention strategies.
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Gupta, Bulbul, Achal Gulati, and Divya Gupta. "A Rare Presentation of Pellet Injury in the Neck." ISRN Surgery 2011 (May 5, 2011): 1–3. http://dx.doi.org/10.5402/2011/306126.
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Penetrating neck injuries are dangerous and deserve emergency treatment by virtue of the vital structures present underneath. There is a potential risk of unrecognized vascular injury and retained foreign bodies with their associated complications in these wounds. Therefore, an early diagnostic workup to localize the site of injury and an immediate neck exploration are important.
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Moldowan, P. D., R. J. Brooks, and J. D. Litzgus. "Demographics of injuries indicate sexual coercion in a population of Painted Turtles (Chrysemys picta)." Canadian Journal of Zoology 98, no. 4 (April 2020): 269–78. http://dx.doi.org/10.1139/cjz-2019-0238.
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Sexually coercive reproductive tactics are widespread among animals. Males may employ specialized structures to harass, intimidate, or physically harm females to force copulation, and injuries to the head and neck are reported in taxa with sexually coercive mating systems. The mating tactics of Painted Turtles (Chrysemys picta (Schneider, 1783)) are typically described as involving male courtship and female choice. In contrast, female Painted Turtles in our study population display injuries on the head and neck indicative of bite wounds inflicted by sexually dimorphic tomiodonts and weaponized shell morphology of males during reproductive interactions. Using a 24-year data set, we demonstrate population-level trends in soft tissue wounds inflicted by conspecifics. Adult females experienced more wounding than adult males or juveniles, and larger females had a greater probability of wounding than smaller females. Wounding was concentrated on the dorsal head and neck of females, consistent with expectation of sexual coercion. Furthermore, elevated rates of fresh wounding occurred during late summer, concurrent with the breeding period. By assessing wound demographics, we provide indirect evidence that the tomiodonts and shell of male Painted Turtles inflict injury and function as sexual weapons. These findings shed new light on our understanding of mating system complexity in an often-overlooked and difficult-to-observe taxonomic group.
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Vick, Laura R., and Saleem Islam. "Adding Insult to Injury: Neck Exploration for Penetrating Pediatric Neck Trauma." American Surgeon 74, no. 11 (November 2008): 1104–6. http://dx.doi.org/10.1177/000313480807401113.
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Penetrating neck injuries are uncommon in children, and management involves mandatory exploration of the neck. This results in a number of unnecessary operations. Adult experience is moving towards selective exploration. A retrospective review was performed on all trauma patients presenting over the past 10 years. Pediatric patients with penetrating neck injury were selected and data were collected and analyzed. Out of a total of 19,363 trauma patients over the study period, we identified 39 children with 42 penetrating neck injuries. The average age was 13 years, and 56 per cent of cases were male. A large proportion (72%) was African-American. Over half of the injuries (63%) were from projectiles, including gun shot wounds (59%), which tended to be in the older children, whereas animal bites (5) were noted as a predominant cause in the younger ones. Six patients underwent exploration without any preoperative imaging due to penetration of the platysma, and four of these were nontherapeutic. Eighteen patients with platysma penetration underwent directed preoperative imaging, and 15 avoided operative exploration. CT scans were the most common imaging modality (68%). The median injury severity score was 11. The hospital length of stay was longer in the patients who underwent exploration. Mandatory exploration of the neck in children should not be performed unless clinically indicated. Preoperative imaging should be used liberally to limit nontherapeutic explorations, improve diagnostic accuracy, and reduce morbidity.
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Voss, JanOliver, Nadine Thieme, Christian Doll, Stefan Hartwig, Nicolai Adolphs, Max Heiland, and Jan-Dirk Raguse. "Penetrating Foreign Bodies in Head and Neck Trauma: A Surgical Challenge." Craniomaxillofacial Trauma & Reconstruction 11, no. 3 (September 2018): 172–82. http://dx.doi.org/10.1055/s-0038-1642035.
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Penetrating foreign bodies of different origins in the head and neck are rare and potentially dangerous injuries, which might pose problems for their detection, primary care, and final treatment. Depending on the severity of the underlying trauma, some injuries present a higher risk for the presence of foreign bodies. Minor wounds, including common lacerations, are likely to be contaminated with loose gravel debris or dental fragments, and need to be distinguished from severe wounds caused by impalement, shootings, stabbings, and explosions. Blast injuries resulting from terror attacks are challenging recent therapeutic concepts. Even though these injury patterns are uncommon, they carry the risk of impacted objects with dramatic consequences. Despite improving medical imaging techniques, detection remains a challenge as it is dependent on the material of the foreign body, the affected anatomical site, and the injury severity. Therefore, a detailed history of the circumstances leading to trauma is essential when foreign objects are not visible during clinical examination. Precise detection of the foreign body, its anatomical position, and the affected surrounding structures are vital, especially for impalement injuries of the head and neck area. Therefore, an interdisciplinary planning approach is essential prior to removal of the foreign object. Finally, tension-free anatomical adaptation of the corresponding structures is crucial for maintaining and restoring aesthetic and function. Here, we give an overview of the diagnosis and treatment of cases of foreign body injuries encountered in our department.
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Azuaje, Rafael E., Lewis E. Jacobson, Jennifer Glover, Gerardo A. Gomez, George H. Rodman, Thomas A. Broadie, Clark J. Simons, and H. Scott Bjerke. "Reliability of Physical Examination as a Predictor of Vascular Injury after Penetrating Neck Trauma." American Surgeon 69, no. 9 (September 2003): 804–7. http://dx.doi.org/10.1177/000313480306900915.
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The policy of routine angiography (ANG) for all penetrating neck wounds results in a high rate of negative studies. The medical records of all patients who presented to Wishard Memorial Hospital and Methodist Hospital of Indiana with penetrating injuries to the neck from January 1992 to April 2001 were reviewed. All patients who were hemodynamically stable underwent four-vessel ANG to evaluate for vascular injury irrespective of findings on physical examination (PE). A total of 216 patients sustained penetrating neck injuries. Patients were divided according to positive or negative PE findings and the results of ANG. Of the 63 patients with a positive PE, 40 (68%) also had a positive ANG finding. Of the 89 patients with negative PE, only 3 had a positive ANG and none of these injuries required operative repair. PE therefore had a 93 per cent sensitivity (SEN) and a 97 per cent negative predictive value (NPV) for predicting the results of ANG. The SEN and NPV of PE for detecting vascular injuries requiring operative repair were both 100 per cent. In this series, no patient with a negative PE had a vascular injury that required operative repair, irrespective of zone of injury. Routine ANG may therefore be unnecessary for patients with penetrating neck injuries and a negative PE.
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Науменко and E. Naumenko. "Stab wounds to the neck. Treatment in the city hospital. (case study)." Journal of New Medical Technologies. eJournal 8, no. 1 (November 5, 2014): 0. http://dx.doi.org/10.12737/7383.
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A clinical case study with patients with severe combined stab wounds to the neck and left shoulder. During the operation, the effective intubation wounded carried anesthetist available through a wound on the front of the neck, which communicates with the cavity ro-toglotki. Made a temporary stop bleeding by applying hemostatic zazhi-atoms. Intraoperatively administered broad-spectrum antibiotics. Introduced tetanus anatok-syn. With further audit revealed multiple injuries external jugular veins, facial veins and mandibular artery extending from the external carotid artery. Produced by ligation of these suck-ing, dressing which does not lead to a violation of cerebral circulation. Achieved sustained hemostasis. Next was performed upper tracheostomy: additional skin incision above the sternal notch. Mouth-stalled nasogastric tube, the wound washed abundantly with antiseptic solutions. Skill layering suturing mucosa of the oropharynx. Also gastrostomy was performed to unload the esophagus and postoperative enteral nutrition. At the same time packed red blood cells transfused, and fresh frozen plasma to replenish blood loss. Hyoid hemmed bottom to the soft tissues of the oral cavity, oropharynx restored. There are three silicone drainage tube into the cavity of the wound. Soft tissues are compared and sutured with interrupted sutures individual. After operation on the third day were removed from drainage surgery. On the 4th day postoperative period - the state of the injured is stable, heavy, in the mind of the patient is adequate.
Recommended in such cases, pay particular attention to the ongoing external and / or roto-pharyngeal bleeding, signs of shock and acute massive blood loss. On hard or fast growing hematoma in the neck; on the dislocation, obstructive, stenotic, valves, suction asphyxia; on the growing phenomenon of respiratory failure; appearing on or exacerbated by focal neurological symptoms.
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Lee, Christine, Ekaterina Tiourin, Sawyer Schuljak, Jonathan Phan, Theodore Heyming, John Schomberg, Elizabeth Wallace, Yigit Guner, and Raj Vyas. "Surgical Treatment of Pediatric Dog-bite Wounds: A 5-year Retrospective Review." Western Journal of Emergency Medicine 22, no. 6 (October 27, 2021): 1301–10. http://dx.doi.org/10.5811/westjem.2021.9.52235.
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Introduction: Dog bites are a significant health concern in the pediatric population. Few studies published to date have stratified the injuries caused by dog bites based on surgical severity to elucidate the contributing risk factors. Methods: We used an electronic hospital database to identify all patients ≤17 years of age treated for dog bites from 2013–2018. Data related to patient demographics, injury type, intervention, dog breed, and payer source were collected. We extracted socioeconomic data from the American Community Survey. Data related to dog breed was obtained from public records on dog licenses. We calculated descriptive statistics as well as relative risk of dog bite by breed. Results: Of 1,252 injuries identified in 967 pediatric patients, 17.1% required consultation with a surgical specialist for repair. Bites affecting the head/neck region were most common (61.7%) and most likely to require operating room intervention (P = 0.002). The relative risk of a patient being bitten in a low-income area was 2.24, compared with 0.46 in a high-income area. Among cases where the breed of dog responsible for the bite was known, the dog breed most commonly associated with severe bites was the pit bull (relative risk vs German shepherd 8.53, relative risk vs unknown, 3.28). Conclusion: The majority of injuries did not require repair and were sufficiently handled by an emergency physician. Repair by a surgical specialist was required <20% of the time, usually for bites affecting the head/neck region. Disparities in the frequency and characteristics of dog bites across socioeconomic levels and dog breeds suggest that public education efforts may decrease the incidence of pediatric dog bites.
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Ankale, N. R., R. S. Mudhol, Rajesh Radhakrishna Havaldar, and Anju Singh. "An Interesting Case of a Butcher Who Attempted to Cut His Neck." Bengal Journal of Otolaryngology and Head Neck Surgery 26, no. 3 (December 7, 2018): 222–26. http://dx.doi.org/10.47210/bjohns.2018.v26i3.213.
Full textAbstract:
Introduction
Cut throat injuries are well recognized in homicide but less recognized in suicides. The incidence of suicide is increasing worldwide owing to the more stressful strenuous lifestyle and other risk factors like substance abuse. Suicide by incising one’s own throat is associated with hesitation marks whereas homicidal wounds are not.
Case Report
We present an interesting case of a suicidal cut throat of the victim being a butcher who was on alcohol abstinence since 3 days with severe injuries of supraglottic larynx and cricopharynx, surprisingly without any evidence of hesitation marks. He underwent immediate neck exploration and suturing of the injured structures without the need of a tracheostomy.
Discussion
A multidisciplinary approach by Otolaryngologists, Psychiatrists, Intensivists, and Anaesthetists is required in the effective management of these victims. A thorough proper early assessment can totally avoid the need of tracheostomy which is recommended in practice, hence preventing complications arising out of this unnecessary but advocated procedure.
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Boyko, V. V., V. V. Krytsak, P. M. Zamyatin, O. M. Shevchenko, D. P. Zamyatin, E. M. Khoroshun, V. V. Negoduyko, and Yu M. Bunin. "A CASE OF SUCCESSFUL COMBINED SURGICAL TREATMENT OF A WOUNDED WITH PURULOUS MEDIASTINITIS AFTER CHEST AND NECK INJURY OF FIRE ORIGIN." Kharkiv Surgical School, no. 3 (September 20, 2022): 67–69. http://dx.doi.org/10.37699/2308-7005.3.2022.12.
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Resume. The purpose of the study was to reveal the main features of the development of purulent mediastinitis in a wounded person with penetrating gunshot wounds of the chest and neck in order to further improve the diagnosis and treatment of this difficult complication.
The work reports on the injured K., 29 years old, with acute purulent-necrotic mediastinitis and late bilateral empyema of the pleura caused by a gunshot wound to the chest and neck.
With early diagnosis of suppurative mediastinitis due to penetrating gunshot wounds of the chest and neck, active surgical tactics including wound dressing, drainage, massive antibiotic therapy, and adequate postoperative care with intensive care generally help to save the patient's life.
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Dokponou, Yao Christian Hugues, Mamoune El Mostarchid, Housni Abderrahmane, Niamien Patrice Koffi, Miloudi Gazzaz, and Brahim El Mostarchid. "Spontaneous Recovery of Penetrating Cervical Spinal Cord Injury with Physiotherapeutic Treatment: Case Report and Review of the Literature." Case Reports in Neurological Medicine 2021 (December 26, 2021): 1–5. http://dx.doi.org/10.1155/2021/3741461.
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Stab wounds to the cervical spine are less common than injuries from road accidents, sports injuries, and falls. The presence of vital, vascular, neural, respiratory, and digestive structures in the neck region mean that this kind of spinal injury is generally critical, and its management is a challenge. We report a unique case of a previously healthy 17-year-old adolescent admitted for quadriplegia secondary to a stab wound to the cervical spine at the C4C5 level. There was no surgical indication. The patient underwent physiotherapy. He showed spontaneous neurological improvement two weeks later and was able to sit on his own and to walk about three months of physical rehabilitation.
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Dewanto, Evan Boedi, Ahmad Yudianto, and Magda Rosalina Hutagalung. "Wound Pattern Profile in Deceased Victims of Traffic Accidents in Raden Said Sukanto Bhayangkara Hospital Jakarta from January 2017 until December 2018." JUXTA: Jurnal Ilmiah Mahasiswa Kedokteran Universitas Airlangga 13, no. 2 (August 10, 2022): 79–82. http://dx.doi.org/10.20473/juxta.v13i22022.79-82.
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Highlights:1. Traffic accidents can cause different types of wounds.2. Traffic accident victims were predominantly male at the age of 26-45 years old. 3. The most found wounds were abrasions and the most affected area were head and neck. AbstractIntroduction: A traffic accident is an incident that happens on the road, such as a car crash that started on the road and leads to injury or death or damaged properties in the surrounding environment. Traffic accident injuries have a different pattern from any other events or violence, such as a mechanical injury due to friction with asphalt. The wounds that are usually found on the victims are abrasion, laceration, contusion, and wounds with fracture. About 70% of traffic accidents in Indonesia are happening in Java. The aim of this study was to determine the wound patterns of victims of traffic accidents, particularly deceased victims recorded in the Forensic Department of Raden Said Sukanto Bhayangkara Hospital Jakarta from January 2017 until December 2018.Methods: This was a descriptive study using secondary data. Consecutive sampling methods were used by using an external examination form obtained from the Forensic Department of Raden Said Sukanto Bhayangkara Hospital Jakarta from January 2017 until December 2018. Age, gender, and wound patterns such as abrasion, laceration, contusion, and wounds with fracture data were taken.Results: 67 cases of traffic accidents were recorded. Male victims were the most common victims (87.5%) within the age of 26–45 years old (42.18%). Abrasions were the most common wounds found (44.92%) and head and neck region were the most affected area (44.09%).Conclusion: The deceased victims of traffic accidents were mostly males aged 26–45 years old. The most common wound found were abrasions and the most affected areas were head and neck region.
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Kong, Victor, Ross Weale, Joanna Blodgett, John Bruce, Grant Laing, and Damian Clarke. "Spectrum of injuries resulting from gunshot wounds in car hijacking: a South African experience." Trauma Surgery & Acute Care Open 3, no. 1 (December 2018): e000260. http://dx.doi.org/10.1136/tsaco-2018-000260.
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BackgroundCar hijacking, known as “carjacking”, is a form of aggravated robbery of a vehicle from the driver frequently involving firearm and is common in South Africa. There is, however, little literature on the spectrum of injuries sustained by victims of car hijacking. The study aimed to describe the spectrum of gunshot wound-related (GSW) injuries and review our experience of management of victims of car hijacking in our trauma center based in South Africa.MethodsA retrospective review was conducted during an 8-year period from January 2010 to January 2018 on all patients who presented with any form of GSW after a car hijacking incident.ResultsDuring the 8-year study period, a total of 101 patients were identified. Seventy-four percent were male (75 of 101) and the mean age was 34 years. The mean time from injury to arrival at our trauma center was 7 hours (rural district: 10 hours, urban district: 4 hours; p<0.001). Seventy-five percent (76 of 101) of all patients sustained GSWs to multiple body regions, whereas the remaining 25% (25 of 101) were confined to a single body region. The most common region involved was the chest (48 cases), followed by the abdomen (46 cases) and neck (34 cases). Sixty-three of the 101 (62%) patients required one or more operative interventions. The most common procedure was laparotomy (28 cases), followed by vascular (20 cases) and neck (14) exploration. Eighteen percent (18 of 101) of all patients required intensive care unit admission. The mean length of hospital stay was 7 days. The overall morbidity was 13% (16 of 101) and the overall mortality was 18% (18 of 101).DiscussionThe spectrum of injuries from GSW related to car hijacking commonly involves close range GSWs to multiple body regions. Torso trauma is common and a substantial proportion of victims require major operative interventions. The mortality from these injuries is significant.Level of EvidenceLevel III.
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Valente-Aguiar, Murilo Sérgio, Ana Cecília Falcão, Teresa Magalhães, and Ricardo Jorge Dinis-Oliveira. "A Cruel Homicide via Blades of a Young Boy under Custody in a Juvenile Correctional Unit." Forensic Sciences 1, no. 1 (March 4, 2021): 4–7. http://dx.doi.org/10.3390/forensicsci1010002.
Full textAbstract:
Cut-throat wounds are traumatic injuries to the anterior or lateral part of the neck, between the larynx and the hyoid bone, or over the larynx (but rarely above or below these limits), produced by a sharp and heavy instrument with a cutting edge. The depths of such wounds are variable. They can reach the spine and can be singular or multiple. The medico-legal etiology of such wounds is commonly homicide, whereas suicides are infrequent, and accidental cases are rare. In this work, we report the homicide of a 16-year-old boy in a juvenile correctional unit, whose throat was cut with cruelty using two blades. The body was then partially charred. A careful examination of the injuries along with the death scene evidence was performed to clarify the cause, circumstances, and mechanism of death.
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Mustafaev, D. M., and V. I. Egorov. "NECK WOUNDS IN SUICIDAL AND SELF-INJURIOUS ACTIONS." Russian Otorhinolaryngology 89, no. 4 (2017): 122–28. http://dx.doi.org/10.18692/1810-4800-2017-4-122-128.
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Alfleesy, Othman. "The less experienced forensic pathologists led to errors in the autopsy of Kennedy's body and an inaccurate medico-legal report." Asploro Journal of Biomedical and Clinical Case Reports 2, no. 1 (February 24, 2019): 6–9. http://dx.doi.org/10.36502/2019/asjbccr.6145.
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Because the assassination of Kennedy was public opinion and from my view, it is an ethical issue, it is time for me to contribute with this scientific and medico-legal opinion (because my age at the assassination was 7 years old). According to the available information I found, nothing about the murder has been as controversial as the nature of Kennedy’s Injuries. Kennedy’s wounds have been a matter of continuing controversy in regard to their numbers, their directions, their nature and type (either entrance or exit). In most reports, all have mentioned that the injuries of Kennedy as follows: Kennedy’s head exploded, Kennedy died as a result of two gunshot wounds, Kennedy has a wound in his back and other in his neck (anterior side) [1]. In many opinions, the forensic pathologists have written about Kennedy’s assassination, on 22 Nov. 1963. These opinions in regard to Kennedy’s autopsy & report, unfortunately, were confused, contradictory, and often have a lot of professional (malpractice) and practical mistakes.
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S. G., Smitha, Suhasini Hanumaiah, and Arunima Sheeja. "Lockdown 1.0 mishaps in Bangalore: an observational study on head and neck injuries." International Journal of Otorhinolaryngology and Head and Neck Surgery 7, no. 7 (June 23, 2021): 1100. http://dx.doi.org/10.18203/issn.2454-5929.ijohns20212443.
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<p class="abstract"><strong>Background:</strong> The government of India imposed a nationwide lockdown from 24 March to 14 April 2020, to contain the highly contagious corona virus. The aim of the study was to reflect upon the psychosocial impact of lockdown 1.0 on the population in terms of assaults, self-inflicted injuries and road traffic accidents during the 21 days of lockdown.</p><p class="abstract"><strong>Methods:</strong> This was a prospective observational study done in KIMS hospital and research centre during nation-wide lockdown 1.0 i.e. from 24 March to 14 April 2020. Patients who visited emergency medicine department with history of assault, self-inflicted injuries, road traffic accidents sustaining injuries to ear, nose, neck and other regions of the face were included in the study.</p><p class="abstract"><strong>Results:</strong> A total of 32 patients who sustained injuries in the head and neck region during the 21-day lockdown period and came to our institution were included. Out of the 32 injuries, 6 injuries were to the ear, 12 to nose,5 to the neck region and 9 to other facial regions. There were 18 assault cases causing head and neck injuries,3 were self-inflicted wounds and rest were injuries due to road traffic accidents.</p><p class="abstract"><strong>Conclusions:</strong> Several problems emerged following the forced quarantine to combat COVID-19. These inexorable circumstances which are beyond normal experience, lead to stress, anxiety and a feeling of helplessness in all. There is a need to ameliorate people’s access to mental health support services geared towards providing measures for developing healthy coping mechanisms during such crisis.</p>
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Vesovic, Natasa, Aleksandar Ristanovic, Vlado Cvijanovic, Dejan Stojkovic, Nebojsa Maric, Vanja Kostovski, Ljubinko Djenic, and Aleksandar Nikolic. "Penetrating neck injury with consequential thoracic complications managed with use of video-assisted thoracoscopic surgery: A case report." Vojnosanitetski pregled 77, no. 3 (2020): 330–34. http://dx.doi.org/10.2298/vsp170904053v.
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Introduction. Penetrating injuries of the neck are potentially life-threatening conditions. They can cause injuries of larynx, trachea, esophagus and major blood vessels in this area. Case report. The patient was a 28-year-old male who was stabbed with broken glass penetrating the front side of the base of his neck. The patient had dyspnea and the wound was inflicted the night before admission to hospital. An otorhinolaryngologist found a stab wound in the region of the left basis of the neck. The wound was 2 cm long with no signs of bleeding and deep injuries of the anatomical structures of the neck. However, since left hemopneumothorax was clinically and radiologically apparent, drainage of the thorax was performed upon admission to the intensive care unit. Initially, 400 mL of hemorrhagic effusion was evacuated. However, 24 hours later the patient became hemodynamically unstable. It was an indication for videoassisted thoracoscopy (VATS). Therefore, VATS was used as a diagnostic method in order to determine the nature of the injury. Intraoperatively, we treated a laceration of pleuropulmonary adhesion which was continuously bleeding from the apex of the thoracic cavity. As a result, adequate surgical hemostasis was achieved. Furthermore, during the three-week postoperative period, thoracic tubes were placed due to the prolonged air leakage. A thoracic tube was placed laterally along with another one which was placed in intercostal space higher. After total reexpansion of the left lung, thoracic tubes were extracted, and the patient was discharged. Conclusion. Nowadays, VATS has become a highly important ultimate treatment of thoracic trauma. This minimally invasive method allows us to verify injury type and localization, to resolve it and further to follow-up evaluation of pathological changes in the lungs, pericardium, mediastinum, pleura and thoracic wall. In the case of stab wounds in the cervical region, any injuries of the lungs and pleura must be taken into consideration.
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NASR, ADONIS, JÉSSICA TAMARA DE OLIVEIRA, MELISSA MELLO MAZEPA, CHRISTINE LIMA CAVALCANTI DE ALBUQUERQUE, GABRIELA SORAYA MARTINI, MARIANA NAZARIO, and FÁBIO HENRIQUE DE CARVALHO. "Evaluation of the use of tomography in penetrating neck trauma." Revista do Colégio Brasileiro de Cirurgiões 42, no. 4 (August 2015): 215–19. http://dx.doi.org/10.1590/0100-69912015004004.
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ABSTRACTObjective:the study has the intention of evaluate the accuracy of computed tomography for the diagnosis of cervical lesions on penetrating neck trauma and also identify the most frequent mechanisms of trauma. Most injured structures, determine the age range and the most prevalent sex.Methods: observational descriptive retrospective study executed by the systematic retrospective review of medical records of all patients victims of penetrating neck trauma that went through surgery and CT scans, admitted into Hospital do Trabalhador, between January 2009 and December 2013.Results:the final sample was of 30 patients, 96.7% of the male sex, the median age was of 28 years old. Most patients suffered injuries by gun (56.7%) and 33,3% suffered stab wounds. The most stricken area of the neck was Zone II (77.8%) and the left side (55.2%). Regarding the structures injured, the CT showed 6.7% lesions on airways but the surgery showed 40% of damaged, with a value of p=0.002. As to damages of the esophagus and pharynx the CT detected 10% of lesions, while surgery found 30% of lesions, therefore with a significant value of p=0.013. As for the analysis the CT showed reliable. As for the analysis of vascular damage, the CT showed to be, in most cases, reliable to the findings during the surgical act.Conclusion:besides the great use of CT for the diagnosis of penetrating neck injuries we can say that this is an exam with low accuracy for the diagnosis of lesions of aerodigestive tract, therefore it is important a clinical correlation for a good diagnosis.as for the vascular lesions and of other structures, the CT had high sensibility and specificity, thus a good exam to be used in overall.
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Ustinchenko, Ihor, Volodymyr Mishalov, and Valerii Voichenko. "Case of victim torture in forensic expert practice." Forensic-medical examination, no. 2 (November 25, 2021): 96–104. http://dx.doi.org/10.24061/2707-8728.2.2021.11.
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The article contains a case of causing violent acts, namely torture, which corresponds to the section «Physical evidence of torture» of the «Istanbul Protocol». The morphological manifestations of bodily injuries are given, which are sufficiently informative for their further assessment by law enforcement agencies as manifestations of torture and torture and other cruel, inhuman or degrading treatment.
Aim of the work. Forensic medical characteristics of morphological manifestations of bodily injury as manifestations of torture and torture and other cruel, inhuman or degrading treatment.
Material and methods. The material of the research was the archival data of the Luhansk Regional Bureau of Forensic Medical Examination. Well-known forensic and statistical research methods were used.
Results. During the forensic examination of the corpse of gr. There were at least 100 injuries in the form of numerous bruises, bruises, wounds, a strangulation furrow on the neck, and changes in the anus.
Conclusion. Revealed during the forensic medical examination of the corpse of gr. M. at least 100 bodily injuries in the form of numerous abrasions, bruises, wounds, a strangulation groove on the neck and changes in the anus were identified by law enforcement agencies as manifestations of torture and torture and other cruel, inhuman or degrading treatment in accordance with the section «Physical evidence torture» of the «Istanbul Protocol».
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Sethi, Rosh K. V., Elliott D. Kozin, Peter J. Fagenholz, Daniel J. Lee, Mark G. Shrime, and Stacey T. Gray. "Epidemiological Survey of Head and Neck Injuries and Trauma in the United States." Otolaryngology–Head and Neck Surgery 151, no. 5 (August 19, 2014): 776–84. http://dx.doi.org/10.1177/0194599814546112.
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Objective Head and neck trauma results in a range of injuries, spanning minor lacerations to life-threatening airway compromise. Few studies provide in-depth analysis of injuries to the head and neck (HN). We aim to (1) describe HN injury prevalence in the US and (2) investigate patient disposition and the outcome of mortality. Study Design Case series with chart review. Setting Nationwide emergency department (ED) sample. Methods The 2011 database was queried for encounters with a primary diagnosis of HN injury, as categorized by the Barell Injury Matrix. Weighted estimates for demographics, injury category, and mechanism were extracted. Predictors of mortality and admission were determined by multivariable regression. Results We identified 131 million ED encounters. A weighted total of 5,418,539 visits were related to primary HN injuries. Average age was 30 (SE = 0.4), and 56.8% were male. Sixty-four percent of injuries were attributed to fall or blunt trauma. Open wounds comprised 41.8% of injuries. The most common procedure was laceration repair (70%). The majority of patients (97%) were discharged home. Mortality rate was less than 1%. Predictors of admission and mortality ( P < .05) included multiple trauma, vessel trauma, and burns. Other risk factors included foreign-body, older age, and male gender. Conclusions Primary HN injuries commonly present to emergency rooms in the US. The majority of HN injuries are non–life threatening and do not require admission to the hospital or result in death. These data have implications for HN injury surveillance and may be used to risk-stratify patients who present with injuries in the acute care setting.
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Hsiou, Chia-Lin, Chih-Chin Hsu, Pei-Wen Liao, Fu-Hua Yang, Ann Nee Lee, and Wei-Hsiang Huang. "Forensic Death Investigations of Dog Bite Injuries in 31 Cats." Animals 12, no. 18 (September 13, 2022): 2404. http://dx.doi.org/10.3390/ani12182404.
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Animal bite injuries are common in free-ranging cats in Taiwan, and most fatal animal bite events are presumed to be caused by dogs. However, speculation regarding animal abuse may occur when carcasses with prominent injuries are found by members of the general public. Local animal protection offices and veterinary clinicians sometimes face difficulties in convincing these individuals by identifying specific features of dog bite injuries in cat carcasses. Therefore, the present study analyzed injury patterns and distribution in 31 necropsied cats with animal bite injuries, and applied deoxyribonucleic acid (DNA) analysis for canine DNA identification in 13 cats. The main necropsy findings included puncture wounds (26 (83.9%)), linear or small, round contusions/abrasions (20 (64.5%)), lacerations/avulsions (17 (54.8%)), abdominal wall rupture/laceration (19 (61.3%)), herniation (16 (51.6%)), fractures (21 (67.7%)), broken claws (16 (51.6%)), and hair tufts on the body surface (28 (90.3%)). The most-commonly injured regions were the ventral thorax and axilla (23 (74.2%)), hind limbs (22 (71.0%)), shoulder-to-dorsal thorax (21 (67.7%)), back and flank (20 (64.5%)), abdomen (19 (61.3%)), neck (19 (61.3%)), and hip/tail/perineum (17 (54.8%)). Canine mitochondrial DNA was identified in 3 out of 11 cases (27.3%) that were sampled using wound swabs and in 4 out of 5 cases that had hair entrapped in broken claws. In conclusion, this study determined the distribution and features of dog bite injuries in cats and developed an elemental method using trace evidence for DNA identification in animal bites.
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Assi, Patrick E., Alixendra Hunzicker, John Jones, John Pemberton, and Michael Samuel Golinko. "An Ode to Gillies and Millard: “The Ten Commandments Applied to Self-Inflicted Head and Neck Gunshot Wounds”." FACE 3, no. 1 (December 14, 2021): 87–102. http://dx.doi.org/10.1177/27325016211064344.
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Within the field of craniofacial trauma surgery, reconstruction following high-energy ballistic injuries to the face remains a daunting task requiring a multidisciplinary approach for best outcomes. These injuries are complex with large defects requiring reconstruction of different lamellae and skeletal buttresses of the face and no 2 are exactly alike. The reconstruction efforts are multidimensional and focus on restoring facial height, width, projection, jaw occlusion, and function. We present a challenging course of a 56 year old patient with a self- inflicted gunshot wound to the face that resulted in devastating injuries to the mandible and midface. We describe our multistage and multiple technique surgical approach that spanned nearly 2 years and 11 operations that included open reduction, internal fixation of extensive facial fractures, primary bone grafting, free fibula for maxillary reconstruction and palatal fistula obliteration, pre-expanded paramedian forehead flap, and mandibular distraction. In reviewing the patient’s course, his complications, and wins, we were inspired by the fundamentals principles of head and neck reconstruction as we interpreted from the famous “Ten Commandments of Drs. Gillies and Millard.” We discuss these Commandments with the reader in our reflection of this challenging reconstruction and hope others, particularly, those in training are encouraged to find application of the “Ten Commandments” we review as they develop their own surgical practices and styles.
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Laher, Naadiyah, B. Ignacio Monzon, and Martin Mauser. "Results of Selective Non-Operative Management for Penetrating Neck Trauma in 594 patients." Albanian Journal of Trauma and Emergency Surgery 7, no. 1 (January 20, 2023): 1114–19. http://dx.doi.org/10.32391/ajtes.v7i1.302.
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Background: The management of penetrating neck trauma (PNT) evolved from a policy of mandatory exploration to one of selective non-operative management (SNOM) based on clinical examination, and the liberal use of Computed Tomography Angiography (CTA) irrespective of the zone of injury for those patients who are stable on presentation.
Methods: A retrospective audit of patients with penetrating neck injuries managed at Chris Hani Baragwanath Academic Hospital (CHBAH) Trauma Unit, from 2010 to 2015 was conducted. Statistical analysis was performed for all collected variables. A p-value of ≤ 0.05 was considered statistically significant.
Results: The results of treatment of 594 patients were reviewed. There was a predominance of young males (93.4%) with a median age of 28 years (IQR 18-67) presenting with injuries in zone 2, left side of the neck, commonly due to stab wounds (89.3%). Immediate surgical exploration was needed in 145(24.4%), while the remaining (75.4%) were investigated with CTA. CTA showed a sensitivity and specificity of over 90% for vascular injuries and more than 80% for aerodigestive injuries. Major vascular injuries were the most common surgical finding. The overall negative exploration rate was 6%, and the mortality 2.5%.
Conclusions: Our unit’s SNOM protocol relies on liberal CTA use. Despite the obvious limitations of a retrospective study our results showed an acceptable negative and non-therapeutic exploration rate and a low incidence of complications and mortality.
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Syre, Peter, Leonardo Rodriguez-Cruz, Rajiv Desai, Karl A. Greene, Robert Hurst, James Schuster, Neil R. Malhotra, and Paul Marcotte. "Civilian gunshot wounds to the atlantoaxial spine: a report of 10 cases treated using a multidisciplinary approach." Journal of Neurosurgery: Spine 19, no. 6 (December 2013): 759–66. http://dx.doi.org/10.3171/2013.8.spine12907.
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Object Gunshot wounds to the atlantoaxial spine are uncommon injuries and rarely require treatment, as a bullet traversing this segment often results in a fatal injury. Additionally, these injuries are typically biomechanically stable. The authors report a series of 10 patients with gunshot wounds involving the lateral mass and/or bodies of the atlantoaxial complex. Their care is discussed and conclusions are drawn from these cases to identify the optimal treatment for these injuries. Methods A retrospective review was conducted of patients presenting to the emergency rooms of 3 institutions with gunshot wounds involving the atlantoaxial spine. Mechanism of injury and neurological status were obtained, as was the extent of the osteoligamentous, vascular, and neurological injuries. Nonoperative and operative treatment, complications, and clinical and radiographic outcome were recorded. The data were then analyzed to determine the neurological and biomechanical prognosis of these injuries, the utility of the various diagnostic modalities in the acute management of the injuries, and the nature and effectiveness of the nonoperative and operative treatment modalities. Results Ten patients with gunshot wounds involving the lateral mass and/or bodies of the atlantoaxial complex were identified. All but 2 patients sustained a vertebral artery injury. Each patient was evaluated using cervical radiographs, CT scans, and vascular imaging, 8 in the form of digital subtraction angiography and 2 with high-resolution CT angiography. Uncomplicated patients were treated conservatively using cervical collar immobilization, local wound care, and antibiotics. One patient was treated using a halo for instability and 1 underwent posterior fusion following a posterolateral decompression for delayed myelopathy. One patient underwent transoral resection of a bullet fragment. One patient underwent embolization for a symptomatic arteriovenous fistula and a second patient underwent a neck exploration and a jugular vein ligation. None of the patients received anticoagulation therapy. The mean follow-up duration was 13 months. All but 2 patients regained their previous functional status and all ultimately attained a mechanically stable spine. Conclusions These 10 patients represent a rare form of cervical spine penetrating injury. Unilateral gunshot wounds to the atlantoaxial complex are usually stable and the need for acute surgical intervention is rare. Unilateral vertebral artery injury is well tolerated and any information provided by angiography does not alter the acute management of the patient. Vascular complications from gunshot wounds can be managed effectively by endovascular techniques.
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Yakubu, Alkassim, and Oluwatope A. Mabogunje. "Skin Cancer in Zaria, Nigeria." Tropical Doctor 25, no. 1_suppl (January 1995): 63–67. http://dx.doi.org/10.1177/00494755950250s120.
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Skin cancer from 775 patients in the savannah showed a preponderance of squamous cell carcinoma (SCC) of the leg related to neglected, poorly managed and chronic ulcers or scars from burns or injuries. SCC of the head and neck had no predisposing factor. Malignant melanoma overwhelmingly affected the feet, dermatofibrosarcoma affected the trunk and Kaposi sarcoma affected the limbs. Basal cell carcinoma (BCC) comprised only 2% of all skin cancers. The 18 albino patients had a higher frequency of both SCC and BCC mostly on the head and neck. Excisional surgery was generally effective, the wounds being closed primarily or by means of flaps and skin grafts. However, 98 patients required amputation below the knee for tibial involvement by SCC. The prognosis and health care costs of skin cancer will only be improved if burns and injuries are adequately treated.
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Saple, Pallavi, Shrinivas S. Chavan, Vitthal Dada Kale, Vinayak Kurle, and Abhishek Khond. "Comparative study of primary closure versus non-closure of animal bite injuries in head and neck region: case study of 540 patients." International Journal of Otorhinolaryngology and Head and Neck Surgery 5, no. 6 (October 23, 2019): 1463. http://dx.doi.org/10.18203/issn.2454-5929.ijohns20194540.
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<p class="abstract"><strong>Background:</strong> Rabies is a zoonotic disease caused by lyssavirus and spread through saliva of rabid animal bite. This study was taken to compare primary closure versus non-closure of animal bite wounds.</p><p class="abstract"><strong>Methods:</strong> This is a prospective randomized study. Patients were divided into 2 groups. Group A consisted of patients with non-closure of wounds and group B with primary closure of wounds. Patients were followed up for wound healing time, infection and cosmesis. </p><p class="abstract"><strong>Results:</strong> This study consists of 540 patients (323 males and 217 females). The common age group was paediatric and geriatric age. Most common animal bite was from dogs. The average healing time in non-infected wound in group A versus group B with Lackman’s I and II grading was 10.5±1.25 and 12.5±1.5 days versus 7±1.25 and 8.5±1.5 days respectively. There were 19 cases in group A and 17 cases in group B with infection which subsided with antibiotics in 24 hrs. Cosmesis graded on VSS was better in group B (average 4.03±1.5) as compared to group A (average 2.44±0.185). Only one patient from group A with Lackman’s grade II contacted rabies died 2yrs after the bite.</p><p class="abstract"><strong>Conclusions:</strong> Animal bite wounds over head and neck were found to be more common in paediatric and geriatric population who are more vulnerable. Infection and spread of rabies virus through these wounds can be prevented by thorough debridement and cleaning whereas primary suturing helps in achieving early wound healing and better cosmesis producing a socially and functionally acceptable scar.</p><p class="abstract"> </p>
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Atreya, Alok, Dolendra Rijal, Tanuj Kanchan, and Raghvendra S. Shekhawat. "Abdominal self-stabbing: A case report." Medico-Legal Journal 85, no. 2 (December 9, 2016): 97–99. http://dx.doi.org/10.1177/0025817216683583.
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While abdominal stabbings are frequently associated with homicides, abdominal self-stabbing is uncommon and poses a challenge for the investigators. In cases of sharp force trauma, the presence of hesitation cuts over the neck and extremities help to distinguish self-inflicted injuries from homicides. Hesitation cuts are not associated with self-inflicted sharp force injuries to the abdomen, and thus are of limited use in distinguishing suicidal from homicidal abdominal stab wounds. In this study, we present a case of self-inflicted abdominal stabbing along with a detailed review of literature to help elucidate such cases.
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Krige, JEJ, UK Kotze, R. Sayed, PH Navsaria, and AJ Nicol. "An analysis of predictors of morbidity after stab wounds of the pancreas in 78 consecutive injuries." Annals of The Royal College of Surgeons of England 96, no. 6 (September 2014): 427–33. http://dx.doi.org/10.1308/003588414x13946184901849.
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Introduction Penetrating injuries of the pancreas may result in serious complications. This study assessed the factors influencing morbidity after stab wounds of the pancreas. Methods A retrospective univariate cohort analysis was carried out of 78 patients (74 men) with a median age of 26 years (range: 16–62 years) with stab wounds of the pancreas between 1982 and 2011. Results The median revised trauma score (RTS) was 7.8 (range: 2.0–7.8). Injuries involved the body (n=36), tail (n=24), head/uncinate process (n=16) and neck (n=2) of the pancreas. All 78 patients underwent a laparotomy. Sixty-five patients had AAST (American Association for the Surgery of Trauma) grade I or II pancreatic injuries and thirteen had grade III, IV or V injuries. Eight patients (10.3%) had an initial damage control operation. Sixty-nine patients (84.6%) had drainage of the pancreas only, six had a distal pancreatectomy and one had a pancreaticoduodenectomy. Most pancreas related complications occurred in patients with AAST grade III injuries; eight patients (10.2%) developed a pancreatic fistula. Four patients (5.1%) died. Grade of pancreatic injury (AAST grade I–II vs grade III–V injuries, p<0.001), RTS (odds ratio [OR]: 5.01, 95% confidence interval [CI]: 1.46–17.19, p<0.007), presence of shock on admission (OR: 3.31, 95% CI: 1.16–9.42, p=0.022), need for a blood transfusion (OR: 6.46, 95% CI: 2.40–17.40, p<0.001) and repeat laparotomy (p<0.001) had a significant influence on the development of general complications. Conclusions Although mortality was low after a pancreatic stab wound, morbidity was high. Increasing AAST grade of injury, high RTS, shock on admission to hospital, need for blood transfusion and repeat laparotomy were significant factors related to morbidity.
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Murad, Tasneem, Sheeba Shabir, Khurram Saleem, Yasir Shehzad, Noor ul Ain, and Sadaf Zahra. "Non-fatal firearm injuries, Incidence and Circumstances: Presenting in DHQ Hospital Rawalpindi." Pakistan Journal of Medical and Health Sciences 15, no. 6 (June 30, 2021): 1862–64. http://dx.doi.org/10.53350/pjmhs211561862.
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Objective: To describe the incidence and manner of nonfatal firearm injuries in Rawalpindi District Study design: Observational retrospective study Place and Duration: District Head Quarters Hospital Rawalpindi. Duration of 6 months, from July 2020 to Dec 2020. Methodology: Total 82 patients with nonfatal firearm injuries were included. After approval from ERC committee of DHQ Hospital Rawalpindi, data was obtained from the duplicate copies of medicoleagal reports kept at the Forensic Medicine department t of IIMCT. These reports were carried out by cross ponding author and the demonstrators of Forensic Medicine department of IIMCT. The data was entered on a pre-designed Performa having variables such as demographics, time & place of death, region of body involved, weapon used & month of the year. Results: A total of 82 nonfatal firearm injuries were reported during these 6 months. 87% of the victims of were males encountering injuries 1 to 11 in number with an average of 3 injuries per person. 3o% of these injuries were received on the upper trunk, 32% on the lower trunk, 16% the lower limbs, 13% the upper limb, 3% the head and neck and 6% on the other regions. 68% of the injuries were lacerations, an exit wound was detected in 19% of cases and in 13% only entry wounds were found. Tattooing and burning of the adjacent skin were common in wounds on the upper and lower trunk while comminuted intra articular and shaft fractures were important varieties in the limbs. 86% of the victims were vitally stable, others being critically unstable with GCS ranging till 6/15. Conclusion: The public health issue of firearm-related injuries continues to be a concern. The necessity for a district-based, nationwide reporting system for fatal and nonfatal firearm-related injuries is critical. In Pakistan, these data could be used in the design, implementation, and assessment of preventative programs. Key words: Non fatal, Firearm injuries, Regional injuries
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Liang, Erin, Carl Preiksaitis, and Alexei M. Wagner. "Approach to management of penetrating neck injuries: A case of multiple self-inflicted penetrating knife wounds." Visual Journal of Emergency Medicine 20 (July 2020): 100700. http://dx.doi.org/10.1016/j.visj.2019.100700.
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Crowley, R. Webster, Ricky Medel, and Aaron S. Dumont. "Traumatic high flow vertebral-venous fistula presenting with delayed ischemic stroke: endovascular management with detachable coils and Amplatzer Vascular Plugs." Neurosurgical Focus 26, no. 3 (March 2009): E5. http://dx.doi.org/10.3171/2008.12.focus08274.
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Penetrating injuries to the neck can result in a number of abnormalities that are of interest to neurosurgeons and interventional neuroradiologists. Gunshot or stab wounds may cause damage to the cervical spinal cord, the adjacent osseous and ligamentous structures, and the peripheral or cranial nerves. In addition, a significant percentage of penetrating wounds to this location result in vascular injury. These may present insidiously or acutely and with a variety of symptoms. The authors present the case of a patient in whom an occipital lobe infarction developed roughly 2 months after the patient was struck in the neck by a bullet. He was found to have a complete transection of the left vertebral artery, with an associated vertebral-venous fistula. The fistula was eventually treated endovascularly with a combination of platinum coils and Amplatzer Vascular Plugs. The management is discussed, with specific emphasis on the technical aspects of the case.
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Jovic, Nebojsa. "Reconstruction of facial defects after combat wounding using vascularized pedicled galeal and parietal bony grafts." Vojnosanitetski pregled 59, no. 4 (2002): 363–67. http://dx.doi.org/10.2298/vsp0204363j.
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Combat wounds are basically extensive and destructive. Such injuries cause defects of soft and bone structures of the face and neck. During primary surgical management of maxillofacial combat wounds the principle of minimal bone and soft tissue debridement was respected. Definitive reconstruction of the defect was performed after two or three months, when infection was cured and adjacent tissues were restituted. Each combat wound leaves behind fibrous changes in surrounding tissues. Success of the reconstructive procedures is more certain if flaps with its own blood supply are used, either arterial or vascularized grafts from the other parts of body (by microvascular technique). This paper presents our experiences with galeal flap in reconstruction of facial soft tissue defects, as well as galea, together with external table of parietal bone in reconstruction of soft and bony tissues of maxillofacial region in 15 patients.
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Xydakis, Michael S., Michael D. Fravell, Katherine E. Nasser, and John D. Casler. "Analysis of Battlefield Head and Neck Injuries in Iraq and Afghanistan." Otolaryngology–Head and Neck Surgery 133, no. 4 (October 2005): 497–504. http://dx.doi.org/10.1016/j.otohns.2005.07.003.
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OBJECTIVE: At the time of this study, the 1st place that an injured or ill American soldier in Iraq or Afghanistan would have been evaluated by an ENT–head and neck surgeon was at a tertiary care medical center as a result of air evacuation out of theater: Landstuhl Regional Medical Center (LRMC), Ramstein, Germany. By examining the ENT-related diagnoses of all air evacuations from downrange, we were able to match the patients classified as having battle injuries to determine the percentage with head and neck trauma. STUDY DESIGN: A prospective review of 11,287 soldiers air-evacuated from Afghanistan and Iraq, representing the 1st year of combat operations. A new, computerized patient-tracking system was created by our team to merge several disparate databases to generate and compile our data. RESULTS: The ENT–head and neck surgery department evaluated and primarily managed 8.7% of all patients evacuated out of theater by air to Germany. Other medical and surgical services managed 7.3% of all patients evacuated out of theater with overlapping ENT diagnoses. The number of potential ENT patients increased to 16% when one looked at all head and neck pathology instances seen by all medical and surgical departments hospital-wide. Of all patients air-evacuated and classified as having battle injuries, 21% presented with at least 1 head and neck trauma code. CONCLUSIONS: This is the 1st paper focusing on the role of the ENT–head and neck surgeon in treating a combat population and also the patterns of illness and head and neck injuries in a deployed force in our modern military. Improved soldier body armor has resulted in distinctly new patterns of combat injuries. Unprotected areas of the body account for the majority of injuries. SIGNIFICANCE: These findings should be used to improve the planning and delivery of combat medical care.