In this section
Traumatic neck injuries are rare in children due to their comparatively
short necks, and the relative protection afforded by the mandible and cervical
spine. However, the neck contains a
number of vital structures, that if injured can rapidly lead to a loss of life.
Neck trauma may be blunt, penetrating or a combination of both.
Penetrating neck injuries in the older child may include those from gunshot
wounds, stab wounds, or debris, such as glass or shrapnel, secondary to
experimentation with flammable/explosive materials. Younger children may sustain penetrating
injuries after falls onto objects in their environment (e.g. twigs, fence
posts) or held in their mouth (e.g. toothbrushes) or hands (e.g. pencils,
chopsticks). Blunt injuries tend to be
secondary to motor vehicle accidents, especially if unrestrained, or
motorcyclists (clothes-line or garrotting type injuries). Blunt injuries to the neck may also occur due
to non-accidental injury (strangulation) or hanging.
with neck trauma have commonly been involved in a multi-system trauma requiring
initial assessment following an ATLS protocol.
During the assessment of the neck, consider the four types of vital
structure in the neck.
patient with an apparently stable airway, in the first few hours, may
deteriorate quickly due to oedema. Even
minor signs should still lead to very careful observation.
XR - may show
pneumomediastinum / pleural effusion / hydrothorax / subcutaneous
emphysema in the event of oesophageal perforation
X-rays of neck (soft tissue views) - May show surgical
emphysema and soft tissue swelling, but are unreliable in demonstrating
angiogram of neck - Evidence the role of CT
angiogram of the neck to screen for associated cerebrovascular injury to
carotid and/or vertebral arteries is limited in the paediatric population.
Indications for CT
angiogram of neck in blunt trauma include:
NB: A plain
CT neck, i.e. without contrast, may be better able to identify laryngeal
fracture, but should not be performed in the unstable patient
All patients with signs / symptoms of injury to the neck should be
discussed with ENT for consideration of fibreoptic laryngoscopy.
Initial assessment of
patient along EMST guidelines
IF airway stable:
IF unstable airway
Historically penetrating injuries to the neck have been considered
along the lines of anatomical location, with all injuries in Zone II (between
cricoid and angle of the mandible) requiring surgical exploration, and those in
Zone I (clavicles to cricoid) and III (angle of mandible to base of skull)
Practical management of penetrating neck injury can be considered
along looking for hard or soft signs of injury (see below)
In paediatrics it is prudent to consider stridor as an additional "hard" sign as it may indicate impeding airway loss secondary to bleeding into the airway, or from swelling encroaching on the patency of the airway.
All wounds deep to the platysma,
should be discussed with the ENT team.
Severe vascular injury may require
consultation between the On Call Paediatric Surgeon, the Cardiac Surgery
Consultant, the Plastic Surgery Consultant, the RCH Interventional Radiologist
and/or with the On Call RMH Vascular Surgeon as per the following policy: Severe
Vascular Injury in Children
with local ENT team:
with signs of blunt or penetrating neck trauma should be discussed with ENT
with major trauma, including blunt / penetrating neck trauma, should have
definitive management in the major trauma centre (RCH)
requiring care beyond the comfort level of the hospital
For emergency advice and
paediatric or neonatal ICU transfers, call the Paediatric Infant Perinatal
Emergency Retrieval (PIPER) Service: 1300 137 650. PIPER will in turn arrange consultation with
the RCH Emergency Deartment and ENT teams, in addition to others relevant to