Cervical vascular injuriesĪrterial injuries are seen in approximately 10-25% of patients with 5,7,10,16,17,25 Further technological advances have shown incremental improvements in performance (Table 3). Sensitivities and specificities routinely exceeding 90%. Well for the diagnosis of cervical vascular injuries, with CT angiography, even using older technology, performs Vascular injuries, as stroke is the dreaded consequence of cervical Much of the research on CTA in this setting has been focused on Workhorse for patients with such injuries. Myriad of penetrating neck injuries thus, it has become the evaluation Indications for immediate surgery and those with “soft” signs of neckĬT angiography has been shown to be highly accurate in diagnosing a Immediate surgical exploration (Figure 1). “hard” signs of vascular and/or aerodigestive injuries, require Patients with signs of significant neck injury, particularly those with Patient clinical presentation and symptoms still hold an important place in the management of penetrating neck injuries (PNI). Strategies, pearls and pitfalls will be emphasized This review focuses on image-based evaluation and management asĭictated by neck CTA. Patients with “soft signs” in the setting of penetrating neck injuries 5,6,10,17,23,24,29 A recent prospective multicenter trialĮvaluating 40- and 64-slice MDCT for cervical vascular andĪerodigestive injuries has confirmed its accuracy and utility in Indeed, the shift away from management dictated by wound location andĭepth to a “no zone,” image-based approach has been driven primarily byĬTA. Nontherapeutic surgical neck explorations. Requiring intervention, and it has been shown to significantly decrease The modality is highly accurate in diagnosing and excluding injuries Time and optimize resources was therefore desirable.ĬT angiography (CTA) has emerged as a quick, reliable and accurate tool for evaluating these patients 1,5-7,10,23-27 A more comprehensive test to limit evaluation Tests require additional time and expertise, which may not always beĪvailable at all centers. Laryngoscopy and esophagography, all of which have focused utility andĪre tailored to evaluating specific anatomy. Semi-invasive tests, including catheter angiography, endoscopy, Zone III injuries were managed with a battery of invasive and Due to the difficult surgical exposure, zone I and Mandatory exploration, regardless of patient vital signs and additional This approach, patients with wounds to zone II of the neck underwent Management algorithms based on neck zonal anatomy (Table 1) and wound depth were developed in the 1970’s. Owing to the fear of missing a clinically occult vascular orĪerodigestive injury, 7,8 all the while acknowledging that approximately 50-60% of these explorations would be nontherapeutic. Historically, a low threshold for surgical exploration was employed, 1-6Īdded to this anatomic complexity is the fact that patients may haveĬlinically silent or unsuspected injuries that require intervention. Mortality of penetrating injuries to the neck, which ranges from 2-10%. ThisĪnatomic consideration is a key factor contributing to the overall Structures packed into such a small space than in the neck. Perhaps nowhere else in the human body is there a collection of vital
0 Comments
Leave a Reply. |
AuthorWrite something about yourself. No need to be fancy, just an overview. ArchivesCategories |