Penetrating Neck Trauma
Annotation for Point F
Those patients with symptomatic Zone II injuries should undergo early operative neck exploration by either the standard anterior sternocleidomastoid incision or cervical collar incision, depending on the nature of the injury. If during operative exploration an adequate evaluation of the trachea or esophagus cannot be performed or the trajectory of the wounds elicits concern for aerodigestive injury, ontable bronchoscopy and esophagoscopy can be performed and are adequate to rule out significant aerodigestive injury.4 Hemodynamically stable patients with Zone II injury without symptoms or suspicion can be safely managed expectantly with observation/serial examinations. Zone II patients with suspicion for injury but without symptoms on physical examination should undergo CTA of the neck to evaluate for both vascular and aerodigestive injuries.