Table 1 Surgical approaches described and management of complicated injuries
| Â | Anatomical injury: | Management: | Surgical technique | Incidence, morbidity, mortality rate |
|---|---|---|---|---|
Vascular lesions | External jugular veines, anterior jugular veins, and external carotid arteries [4]. | Can be safely ligated if risk of hemorrhage is important. (Singh et al.) | -Compression, tamponnade. -Arteriography and endo-vascular intervention. -In unstable or patients with hard signs: surgical exploration [2]. | - Incidence of vascular injury 25%. -Arterial injury (80% carotid artery, 45% vertebral artery [5]. |
Internal jugular vein [4]. | -Generally innocuous as thrombosis could occlude the vein [2]. -Repair is mandated [5]. | |||
Carotid artery | Repair: Transverse arteriography or angioplasty [2]. | |||
Other major arteries [3]: | Zone I: generally is congruence with cardiothoracic surgeons. | - Thoracotomy or sternotomy could be indicated. | Â | |
Laryngeal and tracheal injury. | Laryngeal and tracheal mucosal macerations [5] | Endoscopy indicated every time there is a suspected [2]. Should be repaired the sooner (less than 24 h) [2]. | - Small mucosal defects, and un-displaced laryngeal fracture could be managed conservatively [2]. - Mucosal maceration * Soft laryngeal stent. * T-tube in trachea [5] | - 10–20% of neck injuries. - Mortality rate for laryngeal and tracheal injuries 20% [5]. |
Significant laryngeal and tracheal displacement. (Singh et al.) | Should be repaired [4]. | - Significant skeletal fracture are associated with soft tissues lesions: Open repair [2]. - Severely displaced laryngeal fracture: stent (prevention of hematoma, synechiae and aspiration [2]. | ||
Esophageal injury. | Cervical esophageal injury [4]. | Often silent injuries. Should be repaired [4]. | Intra-venous antibiotics, nil by mouth and given nutrition [2]. - Two layers closure with wound irrigation. - Debridement and adequate drainage. - Mucosal flap over suture line for protection [4]. | - Main complications: saliva leakage, infection, acid reflux. - 11–17% increase in mortality if delay of 12 h in management [4]. Possible complications [2]: - Mediastinitis - Saliva leakage |
Neurological injuries: | Spinal cord, Cranial nerves (VII, IX, X, XI, XII), sympathetic chains, peripheric nerve roots, branchial plexus. | Incidence 1% of neck lesions, depending on velocity of trauma [2]. | ||