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