Dr Ronald Chin’s View On Head & Neck Trauma

Evaluation of Head & Neck Trauma Issues

Head and neck trauma encompasses a wide spectrum of injuries affecting critical anatomical regions, including the airway, vasculature, nerves, and soft tissues. Such injuries require prompt and systematic evaluation to prevent life-threatening complications and long-term morbidity. This assessment focuses on common traumatic presentations, their evaluation, and management principles.

Airway Injuries

• Clinical Signs: Stridor, hoarseness, subcutaneous emphysema, or visible injury to the neck.
• Evaluation:
  • Immediate airway assessment using the ABC approach.
  • Fiberoptic laryngoscopy or bronchoscopy for suspected internal injuries.
  • Imaging: CT neck with contrast for detailed evaluation.
• Management:
  • Emergency tracheostomy or cricothyroidotomy if airway is compromised.
  • Surgical repair of tracheal or laryngeal injuries.

Vascular Injuries

• Clinical Signs: Expanding neck hematoma, pulsatile bleeding, bruit, or signs of hypovolemic shock.
• Evaluation:
  • Ultrasound (Doppler) or CT angiography for vascular integrity.
  • Endovascular assessment if indicated.
• Management:
  • Pressure dressing for external bleeding.
  • Surgical exploration for active hemorrhage.
  • Endovascular stenting for stable injuries.

Neurological Involvement

• Clinical Signs: Cranial nerve deficits, Horner’s syndrome, or altered mental status.
• Evaluation:
  • Focused neurological examination.
  • MRI for suspected nerve or spinal cord injury.
  • Neurovascular imaging for carotid artery dissection.
• Management:
  • Observation for minor deficits.
  • Surgical repair or decompression for severe injuries.

Facial Trauma

• Clinical Signs: Facial asymmetry, step deformities, or malocclusion.
• Evaluation:
  • Palpation for fractures and imaging (CT scan) for structural assessment.
  • Ophthalmologic evaluation if orbital involvement is suspected.
• Management:
  • Stabilization of fractures with internal fixation.
  • Soft tissue repair for lacerations.

Esophageal and Pharyngeal Injuries

• Clinical Signs: Dysphagia, odynophagia, or subcutaneous emphysema.
• Evaluation:
  • Endoscopy or contrast esophagography to identify perforations.
  • CT scan for associated soft tissue injuries.
• Management:
  • NPO status with IV antibiotics.
  • Surgical repair for perforations or severe injuries.

Soft Tissue Injuries

Suturing of lacerations with consideration for cosmetic outcomes.

Clinical Signs: Contusions, lacerations, or swelling.

Evaluation:

Physical examination for foreign bodies or depth of injury.

Ultrasound or CT for deeper tissue assessment.

Management:

Meticulous wound cleaning and debridement.

Conclusion

Head and neck trauma demands a multidisciplinary approach due to the complexity and proximity of vital structures. Early identification of life-threatening injuries and timely intervention can significantly improve outcomes. Collaboration with trauma surgery, neurosurgery, and radiology is often necessary for comprehensive management.