Zones of the Neck

• Defined by mandible, cricoid cartilage, and sternal notch.
• Most injuries sustained in Zone II, especially carotid injuries
• Zone I mortality high due to intrathoracic injuries.
• Posterior triangle with few vital structures. Important exception is subclavian at risk just above clavicle.

Rapid Assessment

• Speak (voice change: hoarse, dysphonia)
• Cough (hemoptysis)
• Swallow (dysphagia)
• Carotid auscultation (bruit, thrill)
• Symmetric pulses

Penetrating Trauma

• Based on the Eastern Association for the Surgery of Trauma (EAST) Guidelines
• Unstable: Surgical exploration
• Stable: CTA initial study of choice all zones and blunt
• C-spine immobilization not required for isolated penetrating trauma if patient awake and neuro intact1.

1. Arterial injury

• CTA or US in Zone II
• US up to 100% Sn & Sp for arterial injury
• Angio if positive or inconclusive (s.a. streak artifact)
•  IR can diagnose and embolize (esp Zone III)
• Noncontrast CT sufficient if trajectory remote to vessels

2. Laryngeal injuries

• – Direct laryngoscopy for suspicious wounds
• – CTA

3. Esophageal injuries

• Not excluded by normal x-rays
• Contrast esophagoscopy or esophagraphy (Gastrografin → Barium → Endoscopy)
• Typically done after resuscitative phase

Blunt Neck Trauma

1. Cerebrovascular injuries

• Any neurologic abnormality not attributable to other injuries
• Suspected arterial epistaxis
• High risk head trauma
• US not adequate, CTA is study of choice

2. Esophageal injuries

• Very rare and evaluation only required for symptoms