Penetrating Neck Trauma in a 4-Year-Old Child

Penetrating neck injuries are uncommon in children and a post traumatic common carotid artery to internal jugular vein fistula rarely occurs. We present one case of a 4-year-old girl with a penetrating injury from flying glass fragments in the midportion of the neck, caused by an explosion in a military warehouse. She was referred to our facility upon a request of a hospital of a neighbour country, two days after sustaining a penetrating cervical trauma. The presentation, diagnostic procedures and surgical management of this very rare injury are discussed. No neck penetrating trauma should be underestimated and a selective surgical intervention based on clinical examination and investigation tests findings is associated with good long-term outcomes.

Anesthetic Management of Neck Trauma with Traumatized Airway: A Case Report and Review

Neck trauma with a traumatized airway can be challenging for airway management, as the neck is a vital structure. Case Report: We are reporting on a 33-year-old male worker who suffered an industrial accident. A steel cord severely hit his neck. He was brought to our ER immediately. Upon arrival, he was conscious with stable vital signs. A physical examination revealed that his Adam’s apple was penetrated, and the adjacent soft tissue and structures were visible. A CT scan showed an anterior and left lateral neck penetrating injury with an open wound, exposure of the thyroid cartilage, a left thyroid cartilage fracture, and pneumoderma. He was urgently taken to the operating theater for airway stabilization and underwent six hours of exploration of the laryngopharyngeal cavity and closure of the laryngopharyngeal defect. He was then sent to the ICU. After two months in the hospital, he regularly follows up in the outpatient department. Conclusion: Effective decision-making for neck trauma with a compromised airway is crucial to ensure the patient’s safety.

Forty hours with a traumatic carotid transection： A diagnostic caveat and review of the contemporary management of penetrating neck trauma

Although penetrating neck trauma （PNT） is uncommon, it is associated with the significant morbidity and mortality. The management of PNT has changed significantly over the past 50 years. A radiological assessment now is a vital part of the management with a traditional surgical exploration. A 22 years old male was assaulted by a screwdriver and sustained multiple penetrating neck injuries. A contrast CT scan revealed a focal pseudoaneurysm in the left common carotid artery bulb. There was no active bleeding or any other vascular injuries and the patient remained haemodynamically stable. In view of these findings, he was initially managed conservatively without an open surgical exploration. However, the patient was noted to have an acute drop in his hemoglobin count overnight post injury and the catheter directed angiography showed active bleeding from the pseudoaneurysm. Surgical exploration 40 hours following the initial injury revealed a penetrating injury through both arterial walls of the left carotid bulb which was repaired with a great saphenous vein patch. A percutaneous drain was inserted in the carotid tri- angle and a course of intravenous antibiotics for five days was commenced. The patient recovered well with no complications and remained asymptomatic at five months followup.

A case of tiny foreign body hidden in the neck for 27 years

Neck trauma has the characteristics of diversity,complexity,and danger.Mild injuries generally require debridement and suturing or symptomatic treatment.In severe cases,acute laryngeal obstruction,subcutaneous emphysema,severe deformation and collapse of laryngeal and tracheal cartilage,or damage to adjacent organs may occur.If not diagnosed in a timely manner or mishandled,it can endanger the patient’s life or leave sequelae.If foreign body residue is caused by head and neck trauma,a reasonable judgment should be made based on the patient’s condition and corresponding measures should be taken.Accurate localization of foreign bodies before and during surgery,as well as appropriate surgical methods,are key to ensuring successful treatment.This article reports a case of a small foreign body in the neck admitted to Xianning Central Hospital at the end of January 2023.

Traumatic Retropharyngeal Abscess of Insidious Onset—A Case Report and Literature Review

Retropharyngeal abscess is an abscess of the deep spaces in the neck which if not treated urgently can be life-threatening as a result of airway compromise. It is important to detect and treat very early. It may arise in pediatrics from direct neck trauma which is not very common and fishbone impaction. Direct anterior neck trauma resulting in insidious retropharyngeal abscess has not been widely reported.

Pharyngeal trauma: Two unique case reports

The neck is a complex pathway for numerous critical structures and is defined by layers of fascial planes and spaces. Traumatic interruption of these planes can occur with injury to any of the mucosal structures within the head and neck, and is often seen as a consequence of pharyngeal injury. Here, the identification and management of two interesting and unique cases of penetrating oropharyngeal trauma are discussed: oropharyngeal trauma following abuse, and a self-inflicted pharyngeal wound with subsequent foreign body ingestion. We also review the literature regarding diagnosis, treatment, and management of traumatic pharyngeal perforation, and discuss possible complications.

Severe Cut Throat Injury in a Child: A Case Report and Review of Literature

Background: Cut-throat injury is a potentially fatal condition that may be associated with serious morbidity and mortality. The neck region is particularly at risk of serious injuries due to the location of vital structures, including nerves, viscera, and major vessels. Although cut-throat injury is said to be rare in children, its occurrence has been reported in some series. Management of this condition requires a multidisciplinary approach for a better outcome. Aim: The aim of this report is to highlight the successful management of an alarming case of severe cut-throat injury with associated laryngeal injury in a child. Case presentation: A 12-year-old boy presented with a cut-throat following an assault by an unknown person. Examination revealed an acutely ill child, conscious but pale. He sustained a deep transverse laceration that transected the thyroid cartilage, exposing the laryngeal cavity. An assessment of Zone II penetrating neck injury was made. He was resuscitated, and had emergency neck exploration, tracheostomy, and repair of the injuries. The patient was followed up for 6 months, and had a good voice outcome, with no significant complication. Conclusion: Cut-throat injury is rare in children. But it is a potentially life-threatening condition. It is therefore important to recognize this entity and develop effective protocol of management in our environment.

颈部开放性外伤28例的救治

目的：总结颈部开放性外伤临床救治的经验教训。方法：回顾性分析经手术治疗颈部开放性外伤患者28例（单纯清创12例，气管切开9例，X光定位摘取异物3例，胸腔引流2例，食道修补2例）。结果：治疗效果全部令人满意。结论：处理颈外伤应注意有无重要脏器损伤，警惕隐匿性伤口及出血。及时、正确处理是决定预后的关键。

血管内介入治疗头颈部创伤性血管损伤

目的评估血管内介入治疗颈部外伤性血管损伤的治疗效果。方法回顾血管内介入治疗外伤性颈动脉或椎动脉损伤16例,分析其临床及影像表现,血管内介入治疗(栓塞或支架植入)和预后。结果 16例患者中,男性14例,女性2例,年龄17～46岁。血管损伤的原因有车祸,摔伤,刀伤和斗殴。2例(12.5%)有多处损伤;12例假性动脉瘤,5例动静脉瘘,2例动脉破裂有活动性出血。共20处病变中,行栓塞治疗14处,支架植入6处。随访一年内,临床改善或稳定14例,1例支架完全闭塞,1例动静瘘复通。结论合理采用血管内介入治疗头颈部创伤性血管损伤是安全、有效的治疗方法。

综合性护理对严重开放性颌面耳鼻咽喉头颈复合型外伤效果的影响

目的探讨综合性护理对严重开放性颌面耳鼻咽喉头颈复合型外伤效果的影响。方法将76例开放性颌面耳鼻咽喉头颈部复合型外伤患者分为观察组和对照组,每组38例。观察组通过综合性护理的方法对患者病情进行评估,判断威胁患者生命的首要因素,采取针对性的救护措施配合医生实施术前抢救。对照组采用常规护理方法。比较两组患者的满意度、康复程度及焦虑抑郁情况。结果在疾病康复评分以及生活质量改善评分方面,观察组显著优于对照组(P<0.05);观察组患者护理满意度评分显著优于对照组(P<0.05);护理前,两组患者均存在焦虑和抑郁状态,两组患者SAS和SDS无显著性差异(P>0.05),护理后,两组患者的焦虑和抑郁程度均显著改善(P<0.05),观察组患者焦虑和抑郁程度改善更为明显。结论综合性护理的方法用于严重开放性颌面耳鼻咽喉头颈部复合型外伤患者的术前病情评估,简单实用,为采取针对性的护理提供了依据。

颈部开放性外伤并与喉贯通的临床分析

Cobzeanu等从流行病学上总结出颈部损伤的最常见原因为使用利器（刀、叉、玻璃等）袭击或自残导致的颈穿透伤,其次是由于车祸、勒颈或意外跌倒导致的钝伤。喉位于颈前正中部,是维持呼吸的重要生命。颈穿透伤容易伤及喉部使喉、颈贯通,若不能及时正确的处理,会导致喉狭窄、声音嘶哑等后遗症,甚至喉梗阻、失血等严重并发症危急生命。

颈部复合性外伤的急救处理

目的总结严重颈部复合伤患者的救治经验。方法回顾性分析2001年2月至2007年2月收治的43例严重颈部复合伤患者的临床资料。结果根据病变程度和范围,结扎颈总动脉1例,颈内动脉3例;聚四氟乙烯人造血管修复颈内动脉3例。气管内插管22例次,紧急气管切开21例次。喉气管功能的一期重建19例(喉气管单纯整复术12例,气管袖状切除加气管端端吻合4例,胸锁乳突肌锁骨骨膜瓣修补气管3例),喉全切除术1例。胸锁乳突肌修补气管食管瘘3例。43例患者存活40例,死亡3例,其中2例因颈内动脉破裂术后多脏器衰竭死亡,因呼吸道梗阻窒息死亡1例。气管食管瘘修补3例均痊愈。后遗症:7例颈动脉修复或结扎的患者中3例术后出现偏瘫失语。19例喉气管功能的一期重建后遗留喉狭窄及声嘶5例,其中2例严重喉气管狭窄患者长期带气管套管1例,1例经记忆金属支架植入治疗好转。舌下神经和迷走神经损伤各2例,颈交感神经损伤1例,副神经麻痹5例,舌下神经和副神经均损伤2例。结论紧急处理大出血,呼吸困难及失血性休克是颈部外伤抢救成功的关键。早期正确处理颈部重要器官可避免喉气管狭窄和神经系统并发症的发生。

穿透性颈部大血管伤的救治:附6例报道

目的:探讨穿透性颈部大血管伤的救治方法。方法:1999—2010年收治6例穿透性颈部大血管伤患者,损伤的重要血管结构中颈内动脉1例,颈内静脉2例,椎动脉5例。6例患者中,5例行手术探查,1例为外伤性椎动脉假性动脉瘤,采用覆膜支架介入治疗。结果:6例患者均获得成功救治,所有患者存活,止血彻底,无继发性出血,无因脑部供血不足产生的功能障碍;2例患者颈部伤口延期愈合,分泌物非脓性,细菌培养无致病菌。结论:开放性颈部大血管伤以手术探查止血为首要治疗手段,损伤血管首选吻合,闭合性血管损伤介入血管重建值得推荐,椎动脉损伤手术填塞止血是有效的止血措施。

回医理筋疗法治疗颈部筋伤的临床疗效

目的评价回医理筋疗法治疗颈部筋伤疾病的临床疗效。方法选取200例颈部筋伤患者为研究对象,随机分为观察组和对照组,每组各100例,观察组患者接受回医理筋疗法+针灸治疗,对照组患者接受单纯的针灸治疗,一个疗程治疗后,比较两组的临床疗效。结果观察组治疗总有效率(91%)优于对照组(78%)(P<0.05);观察组症状与功能改善评分[(39.3±3.9)分]优于对照组[(28.9±3.5)分](P<0.05);观察组MPQ量表评分优于对照组(P<0.05)。结论回医理筋疗法能明显改善颈部筋伤患者颈部功能,疗效显著,安全可靠。

头颈部严重木竹异物外伤的诊治经验

目的通过对10例严重的头颈部木竹异物外伤病例救治的回顾性分析,总结外科诊治经验。方法选自2008年8月—2014年5月中山大学孙逸仙纪念医院口腔颌面外科收治的10例头颈部木竹异物外伤患者,对其年龄、致伤原因、部位、术前检查、术前评估、手术方式、手术时间、术中出血、异物长度、麻醉方式、术后处理等进行总结分析。结果患者年龄2~76岁,平均40.9岁。跌落伤8例,工业伤2例。6例采用气管切开全麻,3例经鼻插管全麻,1例经口插管全麻。10例异物均被完全取出,长约4.0~17.5 cm(平均9.96 cm)。手术时间30~180 min。术中出血量3~200 mL(平均69 mL),无严重出血病例。随访11~38月,均未出现严重术后并发症,仅1例出现开口型偏斜、2例颈部术后瘢痕不适。结论术前详细检查、评估以及充分的术前准备十分必要;多学科多手段为安全取出严重的头颈外伤性木竹异物提供保障。

对严重开放性颌面耳鼻咽喉头颈复合型外伤的护理

目的探讨对严重开放性颌面耳鼻咽喉头颈部复合型外伤患者入院至手术前高危时期病情进行准确评估并进行护理的方法,提高术前的抢救成功率,为顺利手术奠定基础。方法对57例开放性颌面耳鼻咽喉头颈部复合型外伤患者,护士通过"看、问、听、摸、测"的方法对患者病情进行评估,判断出威胁患者生命的首要因素,采取针对性的救护措施配合医生实施术前抢救。结果 57例患者均顺利完成手术,痊愈出院,无1例死亡。结论"看、问、听、摸、测"的方法用于严重开放性颌面耳鼻咽喉头颈部复合型外伤患者的术前病情评估,简单实用,为采取针对性的护理提供了依据。

颈部巨大皮肤软组织缺损的修复

目的:总结修复颈部巨大皮肤软组织缺损的经验。方法:彻底清创后于创面同侧肩背部设计和切取斜方肌肌皮瓣,通过明道转移覆盖创面,供瓣区游离植皮或直接拉拢缝合封闭。结果:11例颈部巨大缺损创面应用斜方肌岛状肌皮瓣转移覆盖修复均Ⅰ期愈合,术后未发生颈部血管破裂大出血,未出现垂肩和上肢外展受限等并发症,外形和功能恢复良好。结论:颈部巨大软组织缺损常常合并有颈部大血管和神经的损伤和暴露,应用斜方肌岛状肌皮瓣转移修复效果可靠,抗感染和生物清洁作用强,切取容易,操作简便。

创伤性股骨头坏死中骨细胞凋亡初探

[目的]初步探索骨细胞凋亡与创伤性股骨头坏死的关系。[方法]采用光镜观察(HE)、Hoechest33258荧光染色及Bcl2蛋白免疫组化染色对股骨颈骨折和创伤性股骨头坏死患者共30例(分为早、中、晚期组)和10例正常对照的股骨头标本进行组织学观察、骨细胞凋亡和Bcl2蛋白检测。[结果]与对照组相比,30例标本中均可见不同程度的空骨陷窝化。其中,早期组骨细胞凋亡活性强于其它组,中期标本的骨细胞的凋亡活性降低、Bcl2表达增强,而晚期标本几乎不能检测到骨细胞凋亡和Bcl2表达,差异均有显著性意义(P<0.05)。[结论]骨细胞凋亡参与了创伤性股骨头坏死的早期发病过程,适当的干预可能是改善患者预后的关键。

颈部创伤的急救治疗探讨

目的探讨颈部创伤紧急救治的临床经验与注意事项。方法回顾性分析2006年1月至2008年2月收治的37例严重颈部复合伤患者的临床资料,其中10例颈部异物伤的患者经缝合、修补、结扎重要器官,剔除失活组织,拔除异物等治疗;8例闭合性喉气管外伤的患者,2例行保守治疗,5例行气管切开、环杓关节拨动术治疗,1例行甲状软骨、环状软骨复位术置入喉扩张管的治疗;19例开放性喉气管外伤的患者,15例气管切开但未置喉扩张管的治疗,4例置喉扩张管的治疗。结果32例痊愈出院,4例呼吸通畅,但发音质量稍差,1例因脓胸感染性休克死亡。结论保持呼吸道通畅、止血、抗休克是急救的关键,早期正确处理颈部重要器官可避免喉气管狭窄和神经系统并发症的发生,同时注意食管、甲状腺、喉返神经等损伤的修复也至关重要。

颈部2个皮纹切口与传统“L”形切口颈淋巴结清扫术对机体血清创伤细胞因子的影响

目的：比较颈部2个皮纹切口与传统＂L＂形切口颈淋巴结清扫术对患者机体血清创伤细胞因子白细胞介素（IL）-2,IL-6,C-反应蛋白（CRP）的影响。方法：对2008年12月至2011年7月在新疆医科大学附属肿瘤医院行保留皮神经颈淋巴结清扫术（即保留皮神经的Ⅱ,Ⅲ,Ⅳ,Ⅵ区清扫）的58例甲状腺癌患者按照患者意愿分为2组,第1组26例采用颈部2个横行皮纹小切口行颈淋巴结清扫术,第2组32例采用传统颈部＂L＂形切口行颈淋巴结清扫术,检测并比较2组所有患者的术前1 d、术后1,3,5 d血清细胞因子IL-2,IL-6,CRP的含量。结果：2个皮纹切口与＂L＂形切口术后第1天血清IL-2含量均有下降,但变化差异无统计学意义（P〉0.05）,术后第3天开始两组均恢复到术前水平;两组术后第1天血清IL-6值均升高,术后第3天均有下降,且术后第5天两组均基本恢复到术前水平;两组血清CRP含量术后第1,3天和5天均较术前明显上升,差异有统计学意义（P〈0.05）,2个切口和＂L＂形切口术前和术后组间差异无统计学意义（P〉0.05）。术后随访8~40个月未出现局部及颈部淋巴结复发。结论：颈部2个皮纹切口颈淋巴结清扫术与传统＂L＂形颈淋巴结清扫术相比,对机体血清应激细胞因子影响相当,并不增加创伤性,其在不影响颈淋巴结清扫效果的同时又兼顾了功能与美容,是甲状腺癌保留皮神经的Ⅱ,Ⅲ,Ⅳ,Ⅵ区淋巴结清扫的一种较为理想的手术入路。