Neck Trauma, Blunt, Anterior

Neck Trauma, Blunt, Anterior is a topic covered in the 5-Minute Emergency Consult.

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Basics

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's 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

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

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