Cervical aero-digestive tract injuries at the Johannesburg hospital trauma unit.
Introduction: Cervical trauma poses a great challenge to trauma surgeons, and the anatomical and physiological implications of trauma to this small, compact body region packed with vital structures are enormous. Airway obstruction and exsanguinating haemorrhage are the most important immediate risk to life.
Fortunately aero-digestive tract injuries are relatively uncommon (7% penetrating, very rare in blunt trauma).
In the past 10-15 years surgeons all over the world have changed the classic approach of mandatory exploration of wounds involving the platysma into a selective conservative intervention policy, thus eliminating the risks of non-therapeutic surgical neck explorations.
Method: A description of the retrospective review of prospectively collected data from the digital trauma registry at Charlotte Maxeke Johannesburg Hospital Trauma Unit (JHTU) (Medibank, www.medibank.co.za) of patients diagnosed with aero-digestive injuries (pharynx, larynx, trachea, oesophagus or combined) between January 2005 and December 2009.
Inclusion: penetrating or blunt trauma to the neck, irrespective of associated injuries or final outcome.
Variables collected and discussed: age, sex, mechanism of injury, anatomical location, primary organ injury, associated injuries, Injury Severity Score (ISS) on admission, surgical intervention or non-operative management and overall mortality.
Results: During the study 10 992 patients with major trauma were treated at JHTU. Of those 49 (0.44%) had cervical trauma involving aero-digestive organs. The vast majority were males (N=44; 89.7%) between ages of 15 and 30 years (range 20-50). Forty-three patients had penetrating trauma, 27 (55.1%) presented following gunshot wounds (GSWs), 16 (32.6%) had stab wounds and 6 (12.2%) had blunt mechanisms of injury. The mean calculated ISS was 16 (range 2 - 42). Zone II of the neck was the most common point of entry (N=27, 55.1%).
Laryngeal injury was the commonest, in 18 patients (36.7%, 15 penetrating v. 3 blunt), followed by oesophageal injury in 17 (34.6%, 16 penetrating v. 1 blunt), pharyngeal injury in 14 (28.5, 12 penetrating v. 2 blunt) and tracheal injury in 7 (14.2%, all penetrating); 42 patients (85.7%) had one or more associated injuries.
The majority of the patients underwent emergency surgery (neck exploration and primary repair of injury or primary tracheostomy), and only 7 had non-operative management of their cervical aerodigestive injuries. The overall mortality was 16.3%; there were no deaths related to stab wounds, but 28.5% of patients with GSWs and 33.3% with blunt trauma died.
B M Torres (1), M D C ortega Gonzalez (2), S Motillal (1), M S Moeng (1), J Goosen (1)
(1) Trauma Unit, Charlotte Maxeke Johannesburg Academic Hospital, and Department of Surgery, University of the Witwatersrand, Johannesburg; (2) Department of Anaesthesiology, Chris Hani Baragwanath Hospital and University of the Witwatersrand
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|Title Annotation:||Oral presentations|
|Author:||Torres, B.M.; Gonzalez, M.D.C. Ortega; Motillal, S.; Moeng, M.S.; Goosen, J.|
|Publication:||South African Journal of Surgery|
|Date:||Apr 1, 2011|
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