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Penetrating neck trauma and the need for surgical exploration: six-year experience within a regional trauma centre

Published online by Cambridge University Press:  05 December 2016

A V Kasbekar ,
E J Combellack ,
S G Derbyshire  and
A C Swift
A V Kasbekar*
Affiliation:
Department of Otolaryngology, Head and Neck Surgery, Aintree University Hospital, Liverpool Department of Otolaryngology, Head and Neck Surgery, Nottingham University Hospitals, Nottingham
E J Combellack
Affiliation:
Medical School, Swansea University, Wales, UK
S G Derbyshire
Affiliation:
Department of Otolaryngology, Head and Neck Surgery, Aintree University Hospital, Liverpool
A C Swift
Affiliation:
Department of Otolaryngology, Head and Neck Surgery, Aintree University Hospital, Liverpool
*
Address for correspondence: Mr Anand Kasbekar, Consultant Otologist & ENT Surgeon, Nottingham University Hospitals NHS Trust, Nottingham NG7 2UH, UK Fax: 0115 9709748 E-mail: [email protected]
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Abstract

Background:

There has been a shift towards conservative management of penetrating neck trauma in selected patients.

Methods:

A retrospective case note review of the management of penetrating neck trauma (2007–2013) was undertaken at our large teaching hospital and compared against best-evidenced practice.

Results:

Sixty-three patients were admitted over six years. The incidence of penetrating neck trauma is reducing, contrary to our belief. Most cases were knife inflicted (33 out of 63), and of these most were attempted suicide. There was a high rate of negative findings for neck explorations under general anaesthesia (18 out of 22). Only nine cases had justification for general anaesthesia exploration according to best practice.

Conclusion:

The rate of neck explorations under general anaesthesia has dramatically fallen, in line with best practice. The need for operative intervention in patients with penetration of the aerodigestive tract or a major vascular injury should be based on clinical features, and these have been shown to be reliable indicators prior to open exploration.

Keywords

Neck InjuriesPenetrating WoundsPractice Guideline
Type
Main Articles
Information
The Journal of Laryngology & Otology , Volume 131 , Issue 1 , January 2017 , pp. 8 - 12
Copyright
Copyright © JLO (1984) Limited 2016 

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Footnotes

Presented at the British Academic Conference in Otolaryngology, 8–10 July 2015, Liverpool, UK.

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