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Neck trauma causes a diverse combination of injuries because of the high concentration of critical structures in the neck. Presenting signs of neck injury may be obvious, subtle, or obscured by trauma to other body regions. Missed injuries and delays in diagnosis lead to increased patient morbidity and mortality.


Historical and physical examination findings of vascular, laryngotracheal, or pharynoesophageal injury of the neck are characterized as hard or soft signs (Table 163-1), with 90% of patients with hard signs having an injury requiring emergent repair.

Table 163-1

Signs and Symptoms of Neck Injury

Vascular injuries are the most common cervical injury and cause of death from penetrating neck trauma. Symptoms include frank exsanguination and expanding hematomas, which may cause airway obstruction. Cervical artery injury can also cause various vascular and neurological signs and symptoms (Table 163-2).

Table 163-2

Compiled Screening Criteria for Blunt Cerebral Vascular Injury

Laryngotracheal injuries can present with immediate signs of impending airway obstruction (Table 163-3) or have an insidious onset of airway compromise after a quiescent phase.

Table 163-3

Clinical Factors Indicating Need for Aggressive Airway Management

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