Neck and Airway Injury

Neck and Airway Injury
Paolo Campisi MSc, MD, FRCSC, FAAP
EPIDEMIOLOGY
  • Data on the epidemiology of pediatric neck and airway trauma are limited.
  • In a series of 257 pediatric head and neck trauma patients admitted to an American level I pediatric trauma center1:
    • Male/female ratio 2.5:1.
    • Median age 9.3 years.
    • Leading major head and neck injuries were facial and skull base fractures (32.4%) and blunt and penetrating neck and laryngeal injuries (6.7%).
    • Motor vehicle trauma was the leading cause of injury in children older than 3 years, and falls the most common cause in children under 3 years.
    • Major non-head and neck trauma was present in 35% of patients.
  • In a review of penetrating neck injuries in 31 children2:
    • This form of injury was more prevalent in males; median age was 9.5.
    • Motor vehicle trauma was the leading cause of penetrating injury (32%) followed by gunshot injury (23%).
    • Most (84%) of the penetrating neck injuries occurred in zone II of the neck (see “Classification” later in the chapter).
    • The mortality rate was 9%.
PATHOPHYSIOLOGY
  • Younger children have a relatively prominent cranium and shorter neck.
    • Renders them more prone to intracranial and neurologic injury following head and neck trauma.
  • Laryngeal injuries are also less frequent in the pediatric population due to:
    • A more cephalic position of the larynx that is protected by the mandible.
    • Elasticity of the pediatric laryngotracheal cartilaginous framework.
    • A narrow cricothyroid membrane that is protective against laryngotracheal separation.
  • Neck and airway injuries may result from blunt or penetrating trauma.
  • Blunt trauma causes both crush and shearing injuries:
    • Neck hyperextension results in crush injuries as the larynx is pressed between the offending object and the vertebral column.
    • Sudden changes in momentum also create shearing forces that may cause endolaryngeal mucosal tears, hematomas, and cartilage subluxations.
    • “Clothesline” injury: An extreme form of blunt trauma that can result in laryngeal fracture, cricotracheal separation, vascular injury, and death.
    • Examples of blunt trauma in children include motor vehicle accidents, bicycle accidents, sports-related injuries, blows from fists or feet, and falling or tripping on furniture or stair edges.
  • Penetrating trauma injury is often limited to the pathway of the penetrating object.
    • Degree of injury is directly related to the object’s velocity and mass.
    • Examples of penetrating trauma in children include motor vehicle crashes, gunshot wounds, animal bites, and falls onto sharp objects.
FIGURE 8-1 • Horizontal entry zones for penetrating injuries to the neck.
CLASSIFICATION
  • Neck trauma can be broadly classified into blunt trauma and penetrating trauma.
  • Penetrating neck injuries are further classified in terms of their location in one of three anatomic zones (Fig. 8-1):
    • Zone I: The area between the clavicles and the inferior border of the cricoid cartilage.
    • Zone II: The area between the inferior border of the cricoid cartilage and the angle of the mandible.
    • Zone III: The area between the angle of the mandible and the skull base.
  • Zone II is the most frequently injured area of the neck.2, 3 and 4
  • Zone I and III injuries have a higher mortality rate because surgical exposure is more difficult to achieve.
  • The patient’s stability and the penetrating injury’s anatomic classification are used to determine injury management (Fig. 8-2).4,5
INITIAL MANAGEMENT
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Jun 22, 2016 | Posted by in EMERGENCY MEDICINE | Comments Off on Neck and Airway Injury

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