الفهرس 
Acknowledgements
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Abstract
Trauma represents around 10% of global mortality and 16% of the global burden of disease. Trauma of the cervical region is characterized by its high complexity and high morbidity.
This study is a descriptive retrospective study. The study was conducted in the Emergency and accident unit and Head and neck surgical unit Manchester Royal infirmary, Manchester, United Kingdom and Trauma unit and Otolaryngology department Assiut university Hospital, Assiut, Egypt 15th of April 2018 and 15th June 2020.
This study aimed to review the cases of penetrating neck injuries, compare the outcomes and patterns of trauma in different types of penetrating neck injuries. The recruited patients were divided into two groups based on the requitement center to compare demography, type of trauma and tools causing the injuries in different communities.
Included Patients were divided into three groups according to the type of injury: group of patients with accidental injury, group of patents with suicide injuries and patients with homicide injuries. The three groups were compared regarding age, sex, duration of stay in the hospital, presence of complications, injuries to aerodigestive tract, vascular injuries and the need of neck exploration. This to analyze and detect if the type of injury affects the pattern or outcome of injury.
The included patients were grouped according to the neck zone affected and they were compared regarding age, sex, duration of stay in the hospital, presence of complications, injuries to aerodigestive tract, vascular injuries and the need of neck exploration.
Sixty-five patients were found to be fulfilling the inclusion and exclusion criteria. Seventeen patients were recruited from Assiut university hospitals (AUH) and 48 from Manchester foundation trust (MFT) with percentage (26.15%) and (73.85%). The studied sample included 57 males and eight females with percentage (87.7%) and (12.3%) respectively. All the recruited patients from AUH were males; however, males represented 83.33% of recruited patients from MFT with no statistically significant difference. Patients of AHU were statistically significant younger than the patients of MFT P value 0.0031.
Self-harm was the most common type of injury followed by assault injuries with percentage 43.07% and 41.53% respectively. Accidental injuries accounted 15.38% of total neck injuries and included 10 cases, Males were more than females in each subtype of injury. There is statistically significant higher incidence of self-harm injuries in MFT Patient’s compared to AUH patients’ and higher incidence of assault injuries in AUH patients
Incidence of firearm injuries were statistically significant higher in AUH patients compare to MFT patients but knifes injuries had significant higher incidence in MFT patients than AUH patients with p value 0.0006 and 0.0131 respectively.
Among the patients who had self-harm neck injuries, 16/28 patients (57.14%) had no previous psychological disorders while 12/28 (42.85%) were known to have previous psychological illness. Four patients (4.28%) had previous attempt of self-harm, same number were known to have psychosis and two patients had behavioral disorder.
This study revealed a different pattern of penetrating neck trauma in AUH& MFT and highlights the high incidence of deliberate self-harm, which needs to be addressed prior to patient discharge.
The most affected zone in the neck was zone II which was affected in 66.15% of the patients followed by zone III that was affected in 47.69% of the patients then zone I that was the least affected zone with percentage 15.38%.
Six patients (6/65) (9.23%) needed airway support; four patients (4/6) (6.15%) needed endotracheal intubation and two patients (2/6) (3.07%) needed immediate urgent tracheostomy.
The included patients were managed as following: 31 patients (47.69%) had their wounds sutured under local anesthesia, 30 patients (46.15%) needed to be taken to the operation room. Four patients (6.15%) were managed conservatively. Of the patients who needed to be taken to operation room, 21 patients had neck exploration while the other 9 patients were taken to operation room for suturing of the wounds under general anesthesia. Twenty-one patients underwent neck exploration. Sixteen patients (16/21) (64%) were found to have positive finding of injured neck structure than needed intervention
Nine patients (13.84%) had long-term complications of the injuries. Pneumothorax was the most common complication, and it was diagnosed in three patients.
By comparing the patients regarding type of trauma, there was no statistically significant difference between the accidental, homicidal and suicidal groups regarding pattern and outcomes. By comparing the patients regarding site of trauma, there was no statistically significant difference between the groups regarding age, sex, injury of important neck structure, vascular injury, aerodigestive tract injury, complications, need of airway support and duration of hospital stay.
Patients with multiple zone affection needed neck exploration more than the patients with single zone affection with statistical significant difference of P.value 0.047.
The LOS of the studied patients ranged from 0-34 days. Factors affecting length of stay of included patients were aerodigestive injury, FAI and need for air way support with P value 0.001, 0.034 and 0.027. Also, presence of complications associated with longer duration of hospital stay P value 0.045.