Introduction
Cervical trauma covers injuries to the neck from blunt or penetrating mechanisms that affect the airway, the great vessels, the pharynx and oesophagus, the thyroid and parathyroid glands, the nerves and the cervical spine. The neck holds many vital structures close together, so a missed injury can be fatal within minutes. The exam answer should follow a clear order: airway and bleeding first, then zone-based assessment, then definitive treatment.
Anatomy and classification
The neck is divided into three zones, which guide the likely injuries and the approach to exploration. Zone II (between the cricoid cartilage and the angle of the mandible) is the classic site for surgical exploration in penetrating trauma, but CT angiography is now used to guide decisions in haemodynamically stable patients in all zones.
- Blunt trauma: road traffic accidents, falls, strangulation, hyperextension or flexion injuries of the neck.
- Penetrating trauma: stab wounds, gunshot wounds, glass or other sharp objects; these often involve several structures at once.
- Open injuries (skin broken) and closed injuries (haematoma or internal damage only); a closed injury can still be life-threatening.