Neck Trauma Guidelines

Updated: Jul 12, 2017
  • Author: David B Levy, DO, FAAEM; Chief Editor: Trevor John Mills, MD, MPH  more...
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Guidelines

Guidelines Summary

Western Trauma Association guidelines for neck trauma include the following [38] :

  • Initial management of patients with penetrating neck injury, which violates the platysma, should follow the advanced trauma life support guidelines.
  • Patients who during their primary survey demonstrate ‘hard signs’ or hemodynamic instability require expeditious transfer to the operating room delayed only by securing an unstable airway, with a surgical airway if attempts at oral-tracheal intubation are unsuccessful, and attempting tamponade of active bleeding while en route.
  • Most penetrating neck injuries can be approached via an anterior sternocleidomastoid incision.
  • Zone I neck injuries may require a median sternotomy with extension to an anterior sternocleidomastoid incision or supraclavicular incision with or without clavicular head resection.
  • For Zone II transcervical injuries, a transverse cervical collar incision may provide access to both sides of the neck, with the potential to extend along the anterior sternocleidomastoid muscle.
  • Zone III represents a difficult anatomic zone of injury for distal vascular control. At times, subluxation, dislocation, or resection of the mandible may be necessary to gain operative vascular control.
  • Patients without indications for mandatory neck exploration who remain hemodynamically stable can be managed expectantly with observation/serial examinations or undergo further radiographic evaluation, depending on the level of suspicion for injury, the symptoms demonstrated by the patient, and the anatomic zone of injury.
  • Zone I patients without indications for neck exploration should undergo CTA of the chest and neck to evaluate for both vascular and aerodigestive injuries.
  • In hemodynamically stable patients with CTA evidence of Zone I injury, further intervention is typically required. Successful endovascular approaches for arterial injuries using covered stents for Zone I injuries have been documented.
  • Hemodynamically stable patients with documented Zone I aerodigestive injury by CTA should undergo prompt operative intervention in most cases because this is associated with better outcome.
  • Patients with symptomatic Zone II injuries should undergo early operative neck exploration by either the standard anterior sternocleidomastoid incision or cervical collar incision, depending on the nature of the injury.
  • In hemodynamically stable patients with CTA evidence of Zone II injury, operative intervention is typically required because access is simple and repairs are definitive.
  • Hemodynamically stable Zone III patients with suspicion for injury should undergo CTA of the neck and head to evaluate for vascular and aerodigestive injuries.