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The incidence of penetrating neck trauma is reported to be approximately 1–5% of all traumatic injuries. Innocuous-appearing neck injuries have the potential to cause either immediate or delayed life-threatening injuries and complications. Penetrating neck injuries are generally described according to the zones of the neck. This helps to define the potentially injured structures and allows for a common nomenclature.
This chapter discusses the diagnosis, evaluation and management of neck trauma. It presents special considerations with regard to immobilization and the safety of removing the cervical collar for penetrating neck trauma. High-resolution computed tomography angiography (CTA) is the initial diagnostic study of choice in the stable patient with penetrating neck trauma or blunt neck trauma when blunt cerebrovascular injury is suspected. CTA can be the initial diagnostic study of choice regardless of zone of injury. CTA is particularly useful for zone I and III penetrating injuries, which are more difficult to evaluate by physical examination. Unstable patients with penetrating injuries require immediate surgical consultation and exploration in the OR. Unstable patients include those patients with hard signs: clear airway injury (air bubbling through wound), hemodynamic instability despite resuscitation, uncontrolled bleeding (including expanding hematoma), or evolving neurological deficit.