Role of Tracheostomy in Dealing with Penetrating Neck Trauma: A Double Edged Sword

Background Penetrating neck trauma is an injury in which platysma muscle in neck is breached. It is a life threatening emergency and it requires urgent management by securing airway and neck exploration. Tracheostomy is one of the important procedures as it secures the airway though associated with complications and morbidity in the patients. Case Presentation We present 3 cases of penetrating neck trauma. Each patient is managed by different means of securing airway depending on the site of trauma and associated laryngeal injury. Conclusion Tracheostomy in penetrating neck trauma helps in securing the airway and paves way for safe neck exploration. Minor laryngeal injuries are managed conservatively in order to avoid complications associated with tracheostomy. Tracheostomy and other means of airway management in penetrating neck trauma depend mainly on individualised approach though tracheostomy at a lower site to that of wound should be preferred in major laryngeal injuries. Keywords: Penetrating Neck Trauma; Tracheostomy; Laryngeal Injuries; Airway Management.

A Multidisciplinary Approach to Penetrating Neck Trauma in a Patient with Self-Inflicted Gunshot Injuries to Zones 1-3 of the Neck

Penetrating neck trauma comprises 5%-10% of all traumatic injuries in adults and carries up to a 10% mortality rate for those affected. Management of penetrating neck trauma can be challenging and often requires a multidisciplinary approach. A case of penetrating neck trauma via self-inflicted gunshot wound to zones 1-3 of the neck in an intoxicated, suicidal 60-year-old man is presented. Immediately after stabilization by the trauma surgery team, surgical reconstruction using a pectoralis major pedicled myocutaneous flap was completed by the plastic and reconstructive surgery team. The patient’s hospital course was complicated by injury to the left phrenic nerve, oropharyngeal swallowing dysfunction, and left diaphragmatic dysfunction. The trauma team initiated prompt multidisciplinary responses to each of these complications as they arose by involving the plastic and reconstructive surgery, otolaryngology, gastroenterology, and speech language pathology teams. Early involvement of the physical medicine and rehabilitation, psychiatry, dietary, and pharmacy teams allowed for early optimization and monitoring of the patient’s mobility, psychological, and nutritional statuses. The timely initiation of multidisciplinary care in this patient’s case allowed for the patient to not only to survive a potentially fatal penetrating neck trauma, but to be discharged to a rehabilitation facility with an independent level of function. Given the complications due to severe penetrating neck trauma of zones 1-3 in this case, it is essential for early involvement of the appropriate subspecialty teams in order to achieve the best possible outcome for the patient.