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Penetrating neck trauma in children: a reappraisal
K H Mutabagani1, B L Beaver, D R Cooney
1Department of Surgery, Columbus Children's Hospital, OH 43205, USA.
Insights
Selective management of penetrating neck injuries in children is recommended. A trend toward selective neck exploration, guided by preoperative diagnostics, can reduce unnecessary surgeries in pediatric patients.
Area of Science:
- Pediatric Surgery
- Trauma Management
- Emergency Medicine
Background:
- Penetrating neck injuries in children are rare, with limited data on optimal management strategies.
- Current adult protocols favor selective neck exploration, but pediatric application remains debated.
Purpose of the Study:
- To evaluate the management and outcomes of penetrating neck injuries in children within a specific geographic region.
- To assess the efficacy of diagnostic workups and surgical exploration rates in pediatric cases.
Main Methods:
- Retrospective review of medical records for 46 children (2-16 years) with penetrating neck injuries (1980-1994).
- Injuries were classified by type (missile, stab, bite) and anatomical zone (I, II, III).
- Analysis of diagnostic workup (arteriography, esophagography, endoscopy) and surgical exploration outcomes.
Main Results:
- 55 injuries occurred; 52% missile, 30% stab, 18% dog bites. 58% were in Zone II.
- 21 patients underwent exploration, with a 48% negative exploration rate.
- Explorations for bleeding or positive diagnostics revealed significant injuries; Zone II explorations without these indicators were negative.
Conclusions:
- A selective approach to pediatric penetrating neck injuries, mirroring adult protocols, is advised.
- Emphasis on thorough preoperative diagnostic evaluation can decrease negative neck explorations in children.
- This strategy aims to reduce surgical morbidity and optimize trauma care for pediatric patients.
Abstract:
The management of penetrating neck injuries in adults is controversial, with a trend toward selective neck exploration. These injuries are uncommon in children, and only limited information exists regarding their management. To assess the management of these injuries in the authors' geographic region, they reviewed the records of children with injuries penetrating the platysma muscle who were treated between 1980 and 1994. Forty-six children (aged 2 to 16 years) suffered a total of 55 penetrating neck injuries. The injuries were classified according to type and location. Fifty-two percent were caused by missiles, 30% by stab wounds, and 18% by dog bites. Fifty-eight percent of injuries were in zone II, 31% in zone I, and only 11% in zone III. The diagnostic workup, including arteriography, esophagography, or endoscopy, was performed preoperatively in 10 patients. Overall, 21 patients had exploration, and the rate of negative explorations was 48%. All cases explored for bleeding or a positive diagnostic workup result were found to have significant injury. On the other hand, all neck explorations performed solely because of injury to zone II were negative. The overall morbidity and mortality rates were 31% and 7%, respectively. A more selective approach, similar to that used for adult patients, emphasizing preoperative diagnostic evaluation, is recommended to decrease the rate of negative neck explorations among children.