EMERGENCY MANAGEMENT OF TRAUMA TO THE SOFT-TISSUE OF THE HEAD AND NECK

Most injuries to the head and neck region are accompanied by trauma to the soft tissue. The management of the wound depends on whether it is a superficial or a penetrating trauma. Penetrating traumas may injure bloodvessels, nerve structures and the upper aerodigestive tract. The initial evaluation of a patient with a neck wound should proceed with the basic rules of trauma management (Airway, Bleeding, Circulation). It is suggested, that all wounds deep to the platysma should be explored. Penetrating injuries through the airway should be considered in cases of hoarsness, dyspnea or direct visualization of the airway. In case of dyspnoe the patient should be intubated. In an unstable airway a tracheotomy must be considered. Injuries to the airway demand special care and immediate reconstruction since otherwise it can lead to permanent damage. Hemorrhage and hematoma are the most common symptoms of penetrating neck injuries. Poor initial control of bleeding is the most common cause of death. Uncontrolled clamping of vessels in the neck should be avoided since it can lead to damage of uninvolved structures especially nerves. The neck is divided into 3 zones. Zone I is the area below the sternal notch, Zone II lies between the sternal notch and the angle of the mandible. Zone III is the area above the angle of the mandible. Zone I and III injuries are evaluated with angiography. Zone II injuries are evaluated by surgery. Therapy of Zone I and III is difficult and needs mandibulotomy or resection of the clavicle to gain exposure to the vessels. Penetrating wounds of the digestive tract are mostly diagnosed by the appearance of saliva. In most cases the wound can be closed primarily. If not it should be covered by strab muscles.