[The wounds of the neck]. / Ranenie shei.

The author presents his personal observation of a complex wound on the neck treated with a favourable outcome. Prior to the surgical intervention, the efficient intubation was performed by an anesthesiologist through the wound at the frontal surface of the neck which communicated with the cavity of the oropharynx. The revision showed the injury to the superior thyroid artery branching off from the external carotid artery. Ligation of the vessel did not cause the deterioration of cervical circulation. The long-term hemostasis was achieved, Thereafter, the mid-tracheostomy was performed and the nasogastric tube installed. The wound was copiously washed with an antiseptic solution. The layer by layer suturing of the mucous membrane of the oropharynx was carried out. The hyoid bone was sutured to the soft tissues of the floor of the mouth, and the oropharynx was reconstructed. The soft tissues were juxtaposed and sutured. The rubber graduates were removed on day 3 after the termination of the surgical intervention. The tracheostomy tube and nasogastric tube were removed on the 7th day and the 10th day after surgery respectively. The wound healed by primary intention. The patient was discharged from the hospital in the satisfactory condition on the 14th postoperative day.

Successfully treated transoral crossbow injury to the axial spine causing mild neurologic deficit: case presentation.

PURPOSE: To detail the management, complications and results of a crossbow arrow injury, where the broadhead went through the mouth, tongue, soft palate, C2 vertebra, spinal canal, dural sack, exiting the neck posteriorly and the arrow shaft lodged in the spine causing mild spinal cord injury. METHODS: Case presentation. RESULTS: A penetrating axial cervical spine crossbow injury was treated successfully in spite of the following interdisciplinary complications: meningitis, cerebrospinal fluid leakage, re-bleeding, and cardiac arrest. The shaft was removed from the neck, and C1-3 dorsal stabilization was performed. Controlled Computed Tomography (CT) showed adequate implant position. After 4 months the patient's fine motor skills improved, and he became able to button his shirt on his own, and to eat and drink without any help. Additionally, he was able to walk without any support. At the time of control at the outpatient clinic his behavior was adequate: he cooperated with the examining doctor and answered with short sentences although his psychomotor skills were slightly slower. CONCLUSIONS: Although bow and crossbow spine injuries are rare nowadays they still occur. The removal of a penetrating missile resulting in such a spinal injury required a unique solution. General considerations, such as securing the airway, leaving the penetrating arrow in the neck and immobilizing both the arrow and neck for transport, thorough diagnostic imaging, preventing cerebrospinal fluid leakage, administering prophylactic antibiotics with broad coverage and stabilizing the spine if required, are advised.

Oral, jaw, and neck injury in infants and children: from abusive trauma or intubation?

OBJECTIVES: The objective of this study was to identify the incidence of oral, jaw, and neck injury secondary to endotracheal intubation in young children. METHODS: This prospective observational study was conducted in the pediatric intensive care unit at a level 1 trauma center. From October 1998 to January 1999 and November 2007 to April 2008, all intubated patients younger than 3 years with no prior oral procedures were examined within 24 hours of intubation. A standardized form was used to record injuries. Separately, medical records were reviewed for prior injuries. Chi-square/Fisher exact test was used for statistical analysis. RESULTS: Of 105 patients included in the study, 12 had oral, jaw, or neck injury. One patient had a hard palate injury from a pen cap in his mouth during a seizure. Another broke a tooth biting the laryngoscope blade (the only injury directly attributable to intubation). The remaining 10 patients were determined to be those who experienced abusive trauma. The overall incidence of injury directly from intubation was 0.9%. Oral, jaw, and neck injuries were all significantly associated with abusive trauma (P < 0.001). Eleven patients had difficult intubations: 9 had no injuries, 1 experienced abusive trauma and the second was the patient who broke his tooth during intubation. CONCLUSIONS: Oral, jaw, or neck injury in young children is rarely caused by endotracheal intubation, regardless of difficulty during the procedure.

Camel bite injury to the maxillofacial region: unusual cause and uncommon location.

Animal bite injuries are prevalent worldwide, but the causative animal and the spectrum of injuries are dependent on the kind of animals cohabitating with the human population. Camel bites as a cause are relatively rare. Camels are particularly aggressive, especially during the mating season, when conflicts between the males occasionally lead to dangerous fights resulting in the death of one or both of the combatants. We present a case of camel bite injury to the maxillofacial region inducing an uncommon fracture and the management of both soft and hard tissue injuries, especially addressing the literature for this uncommon bite injury. Because of the unique mode of injury, the ramus was horizontally fractured and displaced. The fracture was also compound because of the deep intraoral bite wounds. The ramal fracture itself is a rare entity. The issue of primary or delayed closure in such cases is addressed.

Larynx, hypopharynx and mandible injury due to external penetrating neck injury.

Esophageal and laryngeal injuries due to ballistic injuries are seldom encountered. Ballistic external neck traumas generally result in death. Incidence of external penetrant neck injuries may vary between 1/5000-137000 patients among emergency service referrals. Vascular injuries, esophagus-hypopharynx perforations, laryngotracheal injuries, bony fractures, and segmentations may be encountered in external neck traumas. Here we report a 27-year-old male patient who was referred to our emergency department and presented with hyoid bone fracture, multiple mandibular fractures, and hypopharynx perforation due to a ballistic external neck injury.

Head-first impact with head protrusion causes noncontiguous injuries of the cadaveric cervical spine.

OBJECTIVE: To simulate horizontally aligned head-first impacts with initial head protrusion using a human cadaveric neck model and to determine biomechanical responses, injuries, and injury severity. DESIGN: Head-first impacts with initial head protrusion were simulated at 2.4 m/s using a human cadaver neck model (n = 10) mounted horizontally to a torso-equivalent mass on a sled and carrying a surrogate head. Macroscopic neck injuries were determined, and ligamentous injuries were quantified using fluoroscopy and visual inspection after the impacts. Representative time-history responses for injured specimens were determined during impact using load cell data and analyses of high-speed video. SETTING: Biomechanics research laboratory. PARTICIPANTS: Cervical spines of 10 human cadavers. MAIN OUTCOME MEASURES: Injury severity at the middle and lower cervical spine was statistically compared using a 2-sample t test (P < 0.05). RESULTS: Neck buckling consisted of hyperflexion at C6/7 and C7/T1 and hyperextension at superior spinal levels. Noncontiguous neck injuries included forward dislocation at C7/T1, spinous process fracture and compression-extension injuries at the middle cervical spine, and atlas and odontoid fractures. Ligamentous injury severity at C7/T1 was significantly greater than at the middle cervical spine. CONCLUSIONS: Distinct injury mechanisms were observed throughout the neck, consisting of extension-compression and posterior shear at the upper and middle cervical spine and flexion-compression and anterior shear at C6/7 and C7/T1. Our experimental results highlight the importance of clinical awareness of potential noncontiguous cervical spine injuries due to head-first sports impacts.

Cervical spine injury response to direct rear head impact.

BACKGROUND: Direct rear head impact can occur during falls, road accidents, or sports accidents. They induce anterior shear, flexion and compression loads suspected to cause flexion-distraction injuries at the cervical spine. However, post-mortem human subject experiments mostly focus on sled impacts and not direct head impacts. METHODS: Six male cadavers were subjected to a direct rear head impact of 3.5 to 5.5 m/s with a 40 kg impactor. The subjects were equipped with accelerometers at the forehead, mouth and sternum. High-speed cameras and stereography were used to track head displacements. Head range of motion in flexion-extension was measured before and after impact for four cadavers. The injuries were assessed from CT scan images and dissection. FINDINGS: Maximum head rotation was between 43 degrees and 78 degrees, maximum cranial-caudal displacement between -12 mm and - 196 mm, and antero-posterior displacement between 90 mm and 139 mm during the impact. Four subjects had flexion-distraction injuries. Anterior vertebral osteophyte identification showed that fractures occurred at adjacent levels of osteophytic bridges. The other two subjects had no anterior osteophytes and suffered from C2 fracture, and one subject also had a C1-C2 subluxation. C6-C7 was the most frequently injured spinal level. INTERPRETATION: Anterior vertebral osteophytes appear to influence the type and position of injuries. Osteophytes would seem to provide stability in flexion for the osteoarthritic cervical spine, but to also lead to stress concentration in levels adjacent to the osteophytes. Clinical management of patients presenting with osteophytes fracture should include neck immobilization and careful follow-up to ensure bone healing.

Functional Outcome Of Delayed Presenting Fracture Neck Of Femur Managed By Cannulated Screw And Fibular Graft.

BACKGROUND: Delayed presenting Fracture neck of femur is one of the complex and challenging fracture to treat. Multiple treatment options are available with varying results. This study was conducted to assess the functional outcome of fracture neck of femur seeking medical attention several days after injury that are managed by cannulated screw and fibular. METHODS: A total of 35 patients were included in the cross-sectional study performed at orthopaedic surgery department of United Medical & dental college Karachi. Adults aged 18 years and over both male and female with fracture neck of femur presenting 14 days after the injury for medical treatment were included in the study. Ethical approval was obtained from the ethical review committee and patients who provided written informed consent were included in study. Data analysis was performed through SPSS version 20. RESULTS: Thirty-five patients with fracture neck of femur of both sexes 25 (71.4%) male and 10 (28.6%) females were included in study. out of which 14 (40%) of the patients had sub-capital fracture and 21 (60%) patients had trans-cervical fracture neck of femur. Mean age of patients was 32.14±10.20 years. Twenty-eight (80%) patients out of 35 had excellent and good outcome, 4 (11.4%) cases had fair and 3 (8.5%) had poor outcome. CONCLUSIONS: Cannulated screw fixation along with non-vascularized fibular graft is effective technique to management of delayed presenting fracture neck of femur as it is easy, inexpensive and does not require any special instrumentation or expertise.

Fireworks Injuries to the Head and Neck: A Retrospective Analysis Between 2008 and 2017.

This study examines firework-associated head and neck injuries in the United States from 2008 to 2017 obtained from a single epidemiology source. The National Electronic Injury Surveillance System (NEISS) was used to collect epidemiologic data and retrospectively analyze firework-associated injuries from 2008 to 2017. Injury types included burns, concussions, contusions, foreign bodies, hematomas, internal organ injury, lacerations, and puncture wounds. Four hundred and thirty-one individuals were originally included; however, 14 participants were excluded due to inadequate injury information. Chi-squared analyses were performed between the following categorical variables: gender vs body part injured, patient age vs injury type, and patient age vs body part injured. About 417 injuries to the head and neck (67.4% male, 32.6% female) were treated in NEISS-reporting emergency departments during the 10-year period. Sixty-nine percent of the injuries occurred in July. Body parts injured included the ear (10.6%), face (61.6%), head (13.0%), mouth (4.8%), and neck (10.0%). Chi-squared analysis demonstrated an association between gender and body part injured (P = .0001). Patient age (P = .066) was independent of injury type. Children aged 0 to 12 years had the highest probability of being injured (40.2%), then adults 22 and older (33.1%) and adolescents 13 to 21 years (26.9%). Given that the preponderance of injuries caused by fireworks occurred primarily in minors, pediatricians should screen for any household firework use during the anticipatory guidance portion of well-child checks, which we believe would improve patient safety and decrease injury rates.

When disaster strikes in the ring: a 20-year study of head and neck injuries secondary to boxing.

The purpose of this study was to explore the patterns of head and neck injuries secondary to boxing. We conducted a 20-year retrospective cross-sectional study using the National Electronic Injury Submission System (NEISS). We derived the predictor variables from both patient and injury characteristics. The principal outcome variable was the probability of hospital admission from the ED. We used bivariate analysis to determine if an association existed between two variables of interest. We created a multiple logistic regression model to model the probability of admission using all significant univariate predictors. The final sample consisted of 1,919 patients. Children were most likely to injure their heads (p < 0.01). Young adults were also most likely to injure their heads (p < 0.05). Adults were most likely to injure their faces (p < 0.01). Children were most likely to incur facial contusions (p < 0.01) and internal organ injuries (p < 0.01). Young adults were most likely to suffer concussions (p < 0.01). Adults were most likely to suffer lacerations (p < 0.01). Certain age groups were more/less likely to injure a particular anatomical site and more/less likely to incur a particular type of injury. Relative to young adults, seniors had an increased odd of admission. Head injuries had an increased odds of admission relative to mouth injuries. Fractures and internal organ injuries proved to be the most dangerous injuries.

Traumatic atlanto-axial rotatory subluxation and dens fracture with subaxial SCIWORA of Brown-Sequard syndrome: A case report.

RATIONALE: A case of traumatic atlanto-axial rotatory subluxation (AARS), dens fracture, rupture of transverse atlantal ligament (TAL), and subaxial spinal cord injury without radiographic abnormality (SCIWORA) of Brown-Sequard syndrome has never been reported in a child. PATIENT CONCERNS: A 7-year-old boy presented to hospital with torticollis, neck pain, and limited neck rotation after a seat-belt injury sustained during a car accident. Neurologic examination revealed right-side motor weakness and left-side sensory abnormality, known as Brown-Sequard syndrome. DIAGNOSIS: Radiologic examinations revealed type II AARS (Fielding and Hawkins classification), increased atlanto-dental interval (ADI) of 4.5 mm due to a type 1B TAL rupture (Dickman classification), a displaced transverse dens fracture along with an ossiculum terminale, and an intramedullary hemorrhage on the right side of the spinal cord at C3-4. INTERVENTIONS: The patient immediately received methylprednisolone, and his motor weakness and sensory abnormality gradually improved. At the same time, the patient underwent initial halter traction for 2 weeks, but he failed to achieve successful reduction and required manual reduction under general anesthesia. OUTCOMES: At the 7-month follow-up visit, radiologic examinations showed a corrected type II AARS that was well maintained and normalization of the ADI to 2 mm. The reduced transverse dens fracture was well maintained but still not united. All clinical symptoms were significantly improved, except the remaining motor weakness of the right upper extremity. LESSONS: To the best of our knowledge, this is the first report of traumatic AARS, dens fracture, TAL rupture, and subaxial SCIWORA of Brown-Sequard syndrome in a child. Appropriate diagnosis and careful treatment strategy are required for successful management of complex cervical injuries in a child.

Ice hockey: a team physician's perspective.

Ice hockey is an exciting sport that is growing in popularity in the United States. Injuries are a common part of the sport, with more injuries occurring in games compared with practice. Higher levels of competition have been shown to correlate with increased frequency of injury. Most frequently, injuries occur to the face, head, and neck, including concussions, contusions, lacerations, and dental injury. Lower extremity injuries include medial collateral ligament injury, meniscus tear, and high ankle sprains. Upper extremity injuries include acromioclavicular joint injury, glenohumeral dislocation, and various contusions and sprains. Groin and lower abdominal strains also are common. Women's hockey participation is increasing, with data that suggest injuries similar to those seen in men's hockey.

When violence strikes the head, neck, and face.

INTRODUCTION: The aim of this study was to find characteristics in head-neck-facial (HNF) injuries among victims of violence and to test the hypothesis that the type of injury, location, and mechanism behind it vary between the genders. METHODS: A 1-year prospective study including all victims of violence attending the Accident & Emergency (A&E) Department or the Institute of Forensic Medicine in Aarhus was conducted. Every violence-related injury was recorded along with the mechanism behind it, the type of injury, and the specific anatomic location. RESULTS: A total of 1,106 victims were examined of whom 83% had HNF injuries. Thirty-seven percent had more than one HNF injury. Injuries around the nose and mouth were significantly associated with male victims, whereas injuries to the neck were significantly more common among female victims. Most injuries were the results of assault with a blunt object, where the men much more frequently had open wounds, whereas injuries such as ecchymoses were significantly more frequent among female victims. Use of weapons, such as blunt objects and blows with glass/bottles, was associated much more with male victims, whereas strangulation attempts were significantly more frequent among women. Ten percent of the women had been exposed to strangulation attempts. DISCUSSION: The findings support former studies that HNF injuries might be considered as markers of violence. Thus, the staff at A&E Departments must consider anyone with these types of injuries as potential victims of violence. The A&E Department may be the primary entrance for the victims and the main way in which to offer help. The high incidence of women who had been assaulted with strangulation, which is a potentially very dangerous trauma mechanism, intensifies the importance of conducting a careful medical examination, in part, because of the possible legal implications. CONCLUSION: HNF injuries are characteristic among victims of violence, although significant differences exist in the type of injuries, the location, and the trauma mechanism between men and women.

Correlation between scar assessment scales and orofacial myofunctional disorders in patients with head and neck burns. / Correlação entre escalas de avaliação da cicatrização e as alterações miofuncionais orofaciais em pacientes com queimaduras de cabeça e pescoço.

PURPOSE: Verify the correlation between two scar assessment scales and the presence of orofacial myofunctional disorders (OMD) in patients with head and neck (H&N) burns. METHODS: Participants of this study were 16 adult individuals with H&N full-thickness burns. Data were collected through assessment of mandibular range of movement and application of the following instruments: Patient and Observer Scar Assessment Scale (POSAS), Vancouver Scar Scale, and Orofacial Myofunctional Evaluation with Scores (OMES). RESULTS: Results showed moderate negative correlation between the variables deglutition, breathing, total score of the functions, total score on the OMES and scores on the scar assessment scales, indicating that the higher (more severe) the scores on these scales, the lower the scores on the items of the OMES (indicative of greater OMD severity). No correlations were observed between the items of the OMES and the POSAS Patient scale. CONCLUSION: Results suggest that there is correlation between scar severity in burn patients, measured through clinical scales, and presence of OMD. Patients who present scores indicative of H&N pathological scars should be immediately referred to orofacial myofunctional assessment.

OBJETIVO: Verificar a correlação entre duas escalas para avaliação das cicatrizes pós-queimaduras com as alterações miofuncionais orofaciais em pacientes queimados. MÉTODO: Participaram do estudo 16 adultos com sequelas de queimaduras de terceiro grau em cabeça e pescoço. As etapas de coleta de dados envolveram: aplicação das escalas de avaliação da cicatrização Patient and Observer Scar Assessment Scales (POSAS) e Vancouver Scar Scale, aplicação da Avaliação Miofuncional Orofacial com Escores Expandidos (AMIOFE-E) e avaliação da mobilidade mandibular. RESULTADOS: Os resultados indicaram correlação negativa moderada entre os itens de deglutição, respiração, escore total de funções e escore total na AMIOFE-E e as escalas de cicatriz, indicando que, quanto mais grave a pontuação nessas escalas, menor a pontuação nos itens do AMIOFE-E (indicativo de maior alteração). Não foram observadas correlações entre os itens da avaliação clínica da motricidade orofacial e a escala de gravidade da cicatriz preenchida pelos pacientes. CONCLUSÃO: Os resultados do presente estudo sugerem que existe uma correlação entre a gravidade da cicatriz de pacientes queimados, medida por meio de escalas médicas, e as alterações miofuncionais orofaciais. Pacientes que apresentarem pontuação indicativa de cicatrizes patológicas em região de cabeça e pescoço devem ser imediatamente encaminhados para avaliação miofuncional orofacial.

A case of Jack Russel Terrier scavenging: Images and three dimensional models for forensic interpretation.

Distinguishing between ante-mortem and post-mortem domestic dog injuries is fundamental in order to correctly find the cause of the death. Although fatal aggressions are chiefly perpetrated by pit bull-type dogs, small dogs are responsible for a significant share of animal bites and can cause high-degree injuries. On the other side, indoor and outdoor scavenging can hinder forensic investigation, consuming parts of the body where crucial forensic features like bruises and wounds have been inflicted. In the case we present, a man died after falling down his house stairs because of a traumatic intracranial haemorrhage. His dog, a Jack Russel Terrier, scavenged a significant portion of his facial superficial and deep tissues, suggesting to the investigators the hypothesis of a brutal aggression. In this paper, we showed how the application of advanced 3D processing and modelling techniques can give a crucial contribution to detect the injuries certainly caused by animal teeth.

Cervical seatbelt sign is not associated with blunt cerebrovascular injury in children: A review of the national trauma databank.

BACKGROUND: Blunt cerebrovascular injury (BCVI) is a rare consequence of blunt trauma. There appears to be benefit to an aggressive approach to screening for BCVI due to catastrophic sequelae of unrecognized injury. However, screening for BCVI carries extensive cost and oncologic risk to young patients. Foundational BCVI studies examined adults primarily, leaving question to the effectiveness of these criteria in children. We sought to evaluate BCVI screening criteria developed in primarily adult populations using a nationally representative pediatric dataset. METHODS: We queried the 2008-2014 National Trauma Data Bank for patients with BCVI. Patients were stratified by age (adults>18yrs, pediatric≤18yrs). Screening factors from the Modified Denver Criteria and Modified Memphis Criteria (GCS≤8, C1C3 cervical fracture, cervical subluxation, seatbelt sign, basilar skull fracture, mid-facial fracture, mandibular fracture, significant blood loss, coma, stroke, and hanging) were examined using univariate analysis and backwards-stepwise logistic regression to verify predictors of BCVI. RESULTS: Blunt injury occurred in 2,174,244 adults and 422,181 children; 5970 adults and 809 children sustained BCVI. In univariate analysis, all screening factors correlated with BCVI in both groups (p < 0.001). When comparing BCVI patients, children more commonly experienced GCS≤8, seatbelt sign, basilar skull fracture, mid-facial fracture, mandibular fracture, and coma (p < 0.05). In multivariable analysis, seatbelt sign was not associated with pediatric BCVI. CONCLUSION: Many adult-associated BCVI risk factors apply to children. Although children more commonly experience seatbelt sign, it does not independently cause increased BCVI risk. Given the rarity of pediatric BCVI, prospective multi-institutional studies are warranted to establish screening criteria specific to children.

Combined penetrating trauma of the head, neck, chest, abdomen and scrotum caused by falling from a high altitude: A case report and literature review.

This report describes an extremely rare case of combined penetrating trauma that includes the head, neck, chest, abdomen and scrotum. A 46-year-old male construction worker fell from a 5-metre-high platform, and a rebar that was fixed vertically on the ground penetrated the scrotum into the pelvic and abdominal cavities, passing through the chest, neck, mouth, and nose to the outside of the body through the left side of the head. The rebar penetrated the oral cavity and was palpable on the anterior side of the neck and abdomen. The head, neck, chest and abdominal CT scan and reconstruction showed brain contusion, fractures of the skull and skull base, subarachnoid haemorrhage, palate injury, tongue injury, injury to the right lobe of the thyroid, pleural effusion, pulmonary contusion, cardiac contusion, injury to the left lobe of the lung, neck and mediastinal emphysema, and pneumothorax. Emergency green channels provide a rescue process for urgent and severe cases and smooth and timely diagnostic and treatment process to save patients' lives. The medical staff worked together as a team for the initial evaluation and rescue. Emergency nurses played an important role in communicating, cooperating, managing insulation and pain, and providing psychological counselling, which greatly enhanced the efficiency and quality of the nursing. After the patient underwent surgery, anti-infection treatment, sedatives, analgesics, nutritional therapy, psychological support, and other intensive treatment measures, he recovered well two months after the injury. Follow-up at 5 and 11 months after discharge showed good recovery.

Compound mechanism of fatal neck injury: A case report of a tiger attack in a zoo.

Fatal injuries caused by attacks by large wild cats are extremely rare in forensic medical practice in Europe. There are very few cases described in the forensic medical literature concerning incidents in zoos similar to the tiger attack on a 58-year-old male zoo employee that we present here. While preparing a runway for tigers, the man was attacked by a male Sumatran tiger. Another zoo employee was an eyewitness to the accident; in his testimony he described the sequence of events in detail. The autopsy showed the injuries typical of a tiger attack: traces of claws and canine teeth indicating that the victim of the attack was knocked down from behind, along with deep and extensive fatal wounds to the neck. The injuries were inflicted by means of a compound mechanism: tissues were penetrated by the animal's canines, crushed with great force (transfixing injury), and violently distended. The skin revealed four characteristic deep wounds caused by canines as well as bite marks resulting from the action of six incisors. The neck area revealed extensive damage, including torn muscles, the esophagus and trachea, large blood vessels of the neck, and fractures of vertebrae C2 and C5 with internal channels resulting directly from penetration by the animal's canines. The mechanism of distension, as a result of the animal jerking its head after biting the victim in the neck, produced a complete tear of the spine and the vertebral arteries, as well as an intramural rupture of the carotid arteries which has never been described before. In the interests of a detailed assessment of bone damage, the cervical spine was macerated. The applied autopsy techniques and detailed analysis of injuries enabled us to demonstrate the compound mechanism that inflicted them, combining penetration of tissues by the canines, crushing, and distension.

Steel-Jawed Leghold Traps and Killing Neck Snares: Similar Injuries Command Change to Agreement on International Humane Trapping Standards.

According to the Agreement on International Humane Trapping Standards (AIHTS), which was signed by the European Community, Canada, and Russia in 1997, killing devices used for the capture of canids and other fur-bearing nonhuman animals should render an animal irreversibly unconscious within 300 s. However, killing neck snares are not included in the agreement. In this commentary, a parallel is drawn between injuries caused by steel-jawed leghold traps, which have been banned by the AIHTS signatory countries, and killing neck snares to demonstrate that these snares should also be included in international humane trapping standards (i.e., AIHTS). Previous scientific investigations have shown that neither manual nor power-killing neck snares can consistently render canids unconscious rapidly. Animals caught in killing neck snares suffer injuries that are similar to or worse than those reported for leg-captured canids. The authors strongly recommend that AIHTS be modified to include killing neck snares and that such devices be subject to the criteria applied to other trapping devices. Alternative restraining trapping devices, which are effective and more humane, are available for capturing wild canids.

[Domestic violence: an analysis of injuries in female victims]. / Violência doméstica: análise das lesões em mulheres.

This study aimed to evaluate the prevalence of head and neck injuries in females based on complaints registered as bodily harm or cruel and unusual punishment at the Women's Defense Precinct in Araçatuba, São Paulo State, Brazil, in 2002. A total of 204 police inquiries were conducted in 2002, resulting in 33 police reports of bodily harm and cruel and unusual punishment to females. The police reports were examined as to victim's age and site of injury. The results showed that injuries are inflicted on various age brackets, with a higher prevalence in children and adolescents. In addition, the highest prevalence of injuries was in the head and neck, encompassing the area where dentists work and where they should be prepared to treat victims of such violence.