Surgery>>>>>Trauma
Question 8#

Neck injuries:

A. Less than 15% penetrating injuries require neck exploration, a majority can be managed conservatively
B. Divided into three zones, with zone I above the angle of the mandible, zone II between the thoracic outlet and angle of mandible, and zone III inferior to the clavicles
C. All patients with neck injury should receive computed tomography angiogram ( CTA) of the neck
D. Patients with dysphagia, hoarseness, hematoma, venous bleeding, hemoptysis, or subcutaneous emphysema should undergo neck exploration

Correct Answer is A

Comment:

Zone I is inferior to the clavicles encompassing the thoracic outlet structures, zone II is between the thoracic outlet and the angle of the mandible, and zone III is above the angle of the mandible. Patients with symptomatic zone I and III injuries should ideally undergo diagnostic imaging before operation if they remain hemodynamically stable. Specific symptoms which indicate further imaging include dysphagia, hoarseness, hematoma, venous bleeding, minor hemoptysis, and subcutaneous emphysema. Symptomatic patients should undergo CTA with further evaluation or operation based upon the imaging findings; less than 15% of penetrating cervical trauma requires neck exploration. Asymptomatic patients are typically observed for 6 to 12 hours. The one caveat is asymptomatic patients with a transcervical gunshot wound; these patients should undergo CTA to determine the track of the bullet. CTA of the neck and chest determines trajectory of the injury tract; further studies are performed based on proximity to major structures. Angiographic diagnosis, particularly of zone III injuries, can then be managed by selective angioembolization.