Epidemiology
mechanism more likely to cause tracheobronchial or pharyngoesophageal injuries
What is penetrating
Signs and symptoms that require immediate definitive airway management (4)
What is stridor, hypoxia, impending airway loss, hemodynamic instability from concomitant vascular injury
Best approach to assess esophageal injury
What is left longitudinal neck incision
Possible approach to zone 1 right sided injury
What is median sternotomy with extension to anterior SCM incision
Treatment of 18 yo M presents with GSW to zone II of neck.
What is assess for hard signs and hemodynamic instability that would necessitate expeditious treatment in the OR
Estimated incidence of tracheobronchial injury
What is 2-3%
hard signs of aerodigestive tract injury (3)
What is air bubbling, massive hemoptysis, massive hematemesis, or significant respiratory distress
best approach to cervical trachea
what is collar incision
Possible approach to distal carotid injury
What is subluxation or resection of the mandible
Anatomic boundaries of zone III of the neck
What is angle of the mandible and base of the skull
Rate of esophageal injury in penetrating neck trauma
What is 5%
next step for stable patient without hard signs of injury
CTA of the neck
best approach tracheal injury extending into the mediastinum
what is median sternotomy **** score answer
these are extremely difficult injuries and there has been promising results with stents, bronchial blockers, and ecmo
Ideal management of injury to vertebral arteries (other than life threatening hemorrhage)
What is endovascular approach
Most likely at risk in an 84 yo F presents with seat belt sign over the anterior neck and stridor after MVC
What is laryngotracheal injury
Mortality associated with penetrating laryngotracheal injury
What is 20%
next step in a stable patient who has unexplained subq or mediastinal emphysema
What is laryngoscopy and bronchoscopy
possible buttress material for aerodigestive injuries (3)
What is SCM, pericardium, or pleura
Approach to IJ injury in a stable patient
What is lateral venorrhaphy and start anticoagulation if possible
Management of penetrating neck injury that shows large extravasation during esophagography
What is surgical exploration via left neck incision, debridement, repair with vicryl sutures, buttress if able, wide drainage, and abx
Single factor that increases the risk of morbidity and mortality with penetrating neck trauma
What is >24 hr delayed recognition of pharyngoesphageal injury
Grading of penetrating esophageal injuries
What is Grade 1: contusion, hematoma, or partial thickness laceration Grade 2: <50% circumference, Grade 3: >50% circumference, Grade 4: segmental loss of devascularization <2cm, Grade 5: segmental loss or devascularization >2cm
Basic principles for aerodigestive injuries
What is debridement of nonviable tissue, identification of the full extent of mucosal injury, primary repair for less than 50% circumferential injury, segmental resection and anastomosis for greater than 50% circumferential injury, tension-free repair, buttressing of the repair and control of contamination.
Repair of concomitant trachea and esophageal injury
What is primary repair of trachea with absorbable monofilament suture, debride esophagus and repair esophagus in 2 layers with absorbable suture, buttress repair with healthy tissue between trachea and esophagus, place drain, abx, contrast study before feeding or removing the drain
Describe management for stab wound to right neck at the level of the hyoid bone with expanding hematoma at stab site
What is right neck exploration with incision anterior to scm, divide omohyoid, ligate facial vein, enter carotid sheath, address injury, protect RLN