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The management of patients with blunt or penetrating neck injuries can be challenging. Seemingly minor injuries can quickly become life threatening. Missed injuries and delayed diagnosis can result in morbidity and mortality. Although ultimate management goals are the same, each mechanism of injury has its own special considerations.

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There is a paucity of data regarding the epidemiology of blunt and penetrating neck trauma. The demographics are expected to mirror those of other trauma victims, particularly in urban settings, with a predominance of young men in the 21- to 30-year-old age group. Penetrating neck trauma is associated with a high incidence of simultaneous injuries to other systems. Multiple injuries occur approximately half of the time.1 Serious injuries following blunt trauma are less common and are probably underreported because many are not initially recognized.

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The neck contains a high concentration of vascular, aerodigestive, and spinal structures in a relatively confined space. Other structures in the neck susceptible to injury are the thyroid and parathyroid glands, the lower cranial nerves, the brachial plexus, and the thoracic duct. Many of these structures are in close proximity to the skin and therefore are vulnerable to injury. Only the spinal cord has bony protection.

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There are several anatomic classifications of the neck. Traditionally, anatomists have defined the neck in terms of anterior and posterior triangles, as divided by the sternocleidomastoid muscle (Figure 257-1). The anterior triangle is bounded by the midline of the neck, the lower border of the mandible, and the anterior border of the sternocleidomastoid muscle. Within this anterior triangle are most major vascular and aerodigestive structures: carotid artery, internal jugular vein, vagus nerve, thyroid gland, larynx, trachea, and esophagus. The boundaries of the posterior triangle are the middle third of the clavicle, the anterior border of the trapezius muscle, and the posterior border of the sternocleidomastoid muscle. The posterior triangle has few vital structures, except at its base, where the subclavian artery and brachial plexus are located.

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Zones of the Neck

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An alternative anatomic classification divides the neck into three zones (Figure 257-2). This classification was established to guide the clinician in the diagnostic and therapeutic management of penetrating injuries. Various authors have defined the zones differently. The most widely used classification is that of Roon and Christensen.2 By their definition, zone I extends from the clavicles to the cricoid cartilage. Zone I includes the vertebral and proximal carotid arteries, major thoracic vessels, superior mediastinum, lungs, esophagus, trachea, thoracic duct, and spinal cord. Zone II extends from the inferior margin of the cricoid cartilage cephalad to the angle of the mandible. Injuries in zone II may involve the carotid and vertebral arteries, jugular veins, esophagus, trachea, larynx, and spinal cord. Zone III is located between the angle ...

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