• Penetrating trauma:

Neck Injurues may be due to:

• Penetrating injury originates from knives in 50% of cases, GSWs in 45% of cases, and shotguns in 5% of cases.

• GSWs, particularly high-velocity bullets

• Vascular injuries arising from penetrating trauma may occur directly, causing a partial or complete transection of the vessel or inducing formation of an intimal flap, arteriovenous fistula, or pseudoaneurysm.

• Injury to the pharynx or the esophagus occurs in 5-15% of cases.
• The larynx or the trachea is injured in 4-12% of cases.

• Major nerve injury occurs in 3-8% of patients sustaining penetrating neck trauma.
• Spinal cord injury originating from penetrating trauma occurs infrequently, and almost always results from direct injury, rather than secondary osseous instability.

• Penetrating neck trauma may precipitate an air embolism.
  • Suspect this entity in patients developing unexpected hypotension and/or arrhythmia, especially in the setting of an increase in central venous pressure.

• Blunt trauma:

• Blunt trauma to the neck typically results from an MVA, but it also occurs in sports ("clothesline tackle"), strangulation, blows from the fists or the feet, and excessive manipulation.
• Blunt neck trauma is capable of provoking injuries that range from a minor contusion or abrasion to life-threatening events.

• Of utmost concern is cervical spine injury.
  • Suspect cervical spine injury in all patients sustaining significant blunt trauma to the head and/or the neck.

• Nonpenetrating trauma is capable of injuring a blood vessel through a multitude of mechanisms.
  • Direct forces are able to shear the vasculature.
  • Excessive rotation/hyperextension of the cervical spine causes distention and stretching of arteries and veins to the point of rupture.
  • Intraoral trauma may extend to the blood supply.
  • Basilar skull fractures may disrupt the intrapetrous portion of the carotid artery.

• Impact to the exposed anterior aspect of the neck may crush the larynx or the trachea, particularly at the cricoid ring, and compress the esophagus against the posterior spinal column.
  • A sudden increase in intratracheal pressure against a closed glottis (e.g., improper wearing of a seat belt), a crush bruise (e.g., clothesline tackle), or a rapid acceleration/deceleration action may cause a tracheal injury.

• Perforation of the pharynx or the esophagus following blunt neck trauma rarely occurs.
  • Initially, the patient may relate no complaints, and the physical examination fails to detect injury.
  • Since the walls of the esophagus are fragile, iatrogenic injury can follow endoscopy, passage of a nasogastric (NG) tube, or inadvertent esophageal intubation.

• Brachial plexus injuries sustained from blunt trauma usually involve the upper nerve roots (C-5 to C-7), diminishing capacity of the upper arm, while sparing strength and sensation of the lower arm.
  • A radical avulsion of the brachial plexus results in a flaccid, anesthetic extremity.