You evaluate an 18 yrs old male who sustained a right sided cervical
laceration during a gang fight. Which of the following is a relative
rather than an absolute indication for neck exploration?
A. Expanding hematoma
B. Dysphagia
C. Dysphonia
D. Pneumothorax
A. Expanding hematoma
B. Dysphagia
C. Dysphonia
D. Pneumothorax
Ans. D.
Pneumothorax
Reports of a
more than 50% incidence of negative explorations of the neck, iatrogenic
complications, and serious injuries overlooked at operation have caused a
reassessment of the dictum that all penetrating neck wounds that violate the
platysmaQ must be explored.
Stable patients with zone II (between the angle of the mandible and the skull)
or zone I (inferior to the cricoid cartilage) injuries, or
multiple neck wounds, should undergo initial angiographyQ
irrespective of the ultimate treatment plan. Algorithms exist for
nonoperative management of asymptomatic patients that employ observation alone
or combinations of vascular and aerodigestive contrast studies and endoscopy.
Nevertheless, recognition of acute signs of airway distress (stridor, hoarse ness,
dysphonia), visceral injury (subcutaneous air, hemoptysis, dysphagia),
hemorrhage (expanding hematoma, unchecked external bleeding), or neurologic
symptoms referable to carotid injury (stroke or altered mental status) or lower
cranial nerve or brachial plexus injury requires formal neck exploration.
Pneumothorax would mandate a chest tube; the necessity for exploration would
depend on clinical judgment and institutional policy.
