Penetrating Neck Trauma

Annotation for Point J

In those stable patients with radiographic evidence of Zone III arterial injury, further diagnostic or therapeutic intervention is often required. Inaccessible arterial injuries may be addressed with embolization when a vessel can be sacrificed or with covered stenting when patency is required.²³  Penetrating vertebral artery injuries are relatively rare but can be challenging.³⁰ One of the largest series for vertebral artery penetrating trauma demonstrated that approximately 20% of patients required emergency surgery for instability necessitating vertebral artery ligation or the use of bone wax compression, while more than 33% required embolization.³¹ More recent series demonstrate that the majority of penetrating vertebral arterial injures can be successfully managed via an endovascular approach.³² Zone III aerodigestive or pharyngeal injuries also require early diagnosis and management.⁵² Pharyngeal penetrating injury carries similar risks of delayed sepsis, descending retropharyngitis, and resultant mediastinitis as esophageal injury does. It has been demonstrated that contrast swallow studies are less sensitive in detecting hypopharyngeal injuries as compared with esophageal injury and flexible nasoendoscopy or video endoscopy should be part of the ‘‘trauma surgeon’s armamentarium.’’^51,53