الفهرس 
IntroductionOnly 14 pages are availabe for public view
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Abstract
Injuries to the neck present a difficult challenge in both diagnosis and management. Successful management requires a thorough understanding of the complex anatomy of the neck. Clinical presentations and physical examination findings also must be reviewed. Some injuries may present dramatically and catastrophically, while others may be more insidious. A thorough and structured approach must be implemented for every patient.
The controversy over mandatory exploration versus selective, nonoperative management is being replaced by discussion about the optimal nonoperative strategy for each zone realizing which structures are at risk for injury. Selective evaluation is based on the symptoms and physical findings, unlike routine imaging in which all patients undergo a complete battery of studies. The diagnosis of injuries in penetrating neck trauma should focus on evaluating vascular, laryngotracheal, and esophageal trauma. Spinal cord and other nervous system trauma must not be overlooked, although there is some controversy about its prevalence.
Similar to adults, the selective management of penetrating neck injuries is a safe, effective strategy in the pediatric population in an experienced pediatric trauma center.
Angiography remains the gold standard for vascular injury diagnosis, but newer imaging modalities primarily helical CT angiography provide an excellent alternative for initial screening and soon may become the primary imaging modality.
MRA and US offer comparable results, but these diagnostic tools are not as practical in the acute injury setting due to operator dependency and limited after hours availability.
Aerodigestive injury can be suggested from physical examination findings, but the combination of endoscopy and esophagography along with bronchoscopy provides a reliable diagnostic modality to identify or rule out esophageal and laryngotracheal injury.
Conclusion:
An alternative in approaching neck injuries, is one which uses angiography (and esophagoscopy / endoscopy) with injuries involving Zones I and III. With Zone I, a preoperative Vascular Surgery consult may be in order; in Zone III, a Neurosurgery consult may prove beneficial. In Zone II, Mandatory Operative Exploration can be recommended without reserve; preoperative angiographic studies are then dependent on the anatomical location of the penetrating wound (i.e. “the suspicious nature”). This approach, does by effect, increase a center’s negative exploration rate, however, the final cost: benefit ratios may improve overall outcome