Penetrating Neck and Laryngeal Trauma

October 20, 2023 from 11:00am ADT to 12:00pm ADT

Grand Ballroom CDE

Penetrating neck trauma occurs in 5-10% of trauma victimsThe cause of death is usually due to hemorrhage Death also occurs due to complete disruption of the larynx or massive soft tissue edemaAttending healthcare providers must have excellent knowledge of head and neck anatomyProper management of neck trauma is critical to preserve the patient’s life, airway, voice, and swallowing functionNeck trauma is classified into blunt or penetrating.  Understanding the mechanism of injury is critical for estimating what structures and tissues may be injuredTreatment begins with the general principles of the trauma victim – ABCDE – and clearance of cervical spine precautionsThis may include securing the airway with endotracheal intubation or surgery (eg. cricothyrotomy, bedside tracheostomy)Following the primary and secondary surveys, flexible laryngoscopy is performed to assess internal injuriesActive hemorrhage and hemodynamic instability necessitate immediate neck explorationIf the patient is stable, vascular and/or esophageal evaluation is required, using angiographic and fluoroscopic imagingDepending on the region(s) of neck injured, surgical exploration is indicated, even if they are stableSymptoms can include voice changes, odynophagia, dysphagia, dyspnea, and neck painPatients may exhibit stridor, hematoma, subcutaneous emphysema, edema, and hemoptysisConservative management for mild injuries includes antibiotics, steroids, anti-reflux medications, and nebulized mistModerate to severe mucosal, vascular, and cartilaginous injuries can be repaired in the operating roomOutcomes for neck trauma patients are generally favourable, while monitoring for possible complications such as granulation tissue formation, laryngeal stenosis and vocal cord immobility

Learning Objectives

At the conclusion of this session, the participant will be able to: 

  1. Triage and assess penetrating and blunt neck trauma, by identifying key signs and symptoms that suggest severe injury
  2. Appropriately workup associated bony, vascular and mucosal injuries in the head and neck that will guide appropriate management; this includes patients with penetrating level II injuries that require operative exploration regardless  
  3. Identify the consulting services to manage the injuries non-operatively or operatively, depending on the severity of injuries sustained

Speakers / Panelists