The platysma is a thin layer of skeletal muscle that attaches inferiorly to subcutaneous tissues overlying the superior parts of the pectoralis major. When considering blunt and penetrating neck trauma, it is helpful to consider the relevant clinical anatomy. 4 Whilst the recommendations we make are based on accepted international guidelines and evidence, we acknowledge that practice may vary internationally because of differences in available resources and training.
We highlight important components of the Advanced Trauma Life Support (ATLS) primary survey pertinent to both types of injury, with a more detailed discussion of airway assessment and management. In this article we describe the relevant clinical anatomy common to both patterns of injury before separate discussion of blunt and penetrating neck trauma. Whilst these two mechanisms have different pathophysiologies and some important differences in management, there is a shared focus on early airway protection when needed. Trauma to the neck can broadly be classified into blunt or penetrating injuries.
3 It is becoming increasingly likely that anaesthetists, as part of a trauma or theatre team, will encounter patients with these complex and potentially life-threatening injuries. 1, 2 In the year ending March 2019, there were approximately 47,000 offences involving a knife or sharp object in England and Wales the highest number since comparable data have been recorded (March 2011). Whilst reported rates are highest in South Africa, Central and South America, the incidence of interpersonal violence rates is increasing in Europe. Sadly, interpersonal violence is a global problem. Injuries in this area can be complex to manage, and airway management maybe particularly perilous.Ĭommon causes of neck trauma include road traffic collisions (RTCs), sporting injuries, and interpersonal violence. In less emergent situations CT scanning plays a valuable role in planning appropriate further management.Īs a narrow conduit for the major blood vessels, aerodigestive tract, and neurological structures passing between the head and the torso, the neck is an especially hazardous area for traumatic injuries. Severe injuries require immediate surgical exploration.