Neck Trauma, Blunt, Anterior

Description

• Blunt anterior neck trauma may result in various injuries to structures in the neck:
  • Vascular:
    • Carotid artery injury (internal, external, common carotid)
    • Vertebral artery injury
    • Intramural hematoma, intimal tear, thrombosis, and pseudoaneurysm
    • Hemorrhage or neck hematoma
  • Laryngotracheal:
    • Laryngeal injuries: Fracture of hyoid bone, thyroid cartilage, cricoid cartilage, cricotracheal separation
    • Vocal cord disruption
    • Dislocation of arytenoid cartilage
    • Tracheal injuries: Hematoma or transection
  • Pharyngoesophageal:
    • Pharynx: Hematoma, perforation
    • Esophagus: Hematoma, perforation
  • Nervous system:
    • Thoracic sympathetic chain wraps around carotid artery: Disruption can result in Horner syndrome
    • Vagus nerve and recurrent laryngeal nerve
    • Cervical nerve roots and spinal cord
  • Cervical spine:
    • Fracture of vertebral body, transverse process, spinous process, etc.
    • Dislocation

Etiology

• Motor vehicle accidents (most common cause):
  • Unrestrained occupants involved in frontal collisions may strike neck on dashboard or steering wheel: “Padded dash syndrome”
  • Shoulder harness (seatbelt) can also cause shearing injury to anterior neck
• Assault: Blows to anterior neck from fists, kicks, or objects
• “Clothesline injury”:
  • Motorcycle, snowmobile, jet ski, or all-terrain vehicle (ATV)
  • Drivers strike neck on cord or wire suspended between 2 objects
• Strangulation

• Head is proportionally larger in children, increasing risk of acceleration–deceleration injury to neck
• Intraoral blow to soft palate may cause carotid thrombosis (e.g., popsicle in mouth of child who falls, pushing the object into soft palate)