[Acute care of soft tissue injuries in the head and neck region]. / Akutversorgung von Weichteilverletzungen im Kopf-Hals-Bereich.

BACKGROUND: Soft tissue injuries are a common consequence of head and neck trauma. With injuries being highly individual and varying depending on the underlying trauma, it is difficult to establish standardized guidelines for head and neck trauma in general. The main goal of this study was to showcase the distribution of soft tissue injury types and the principles pertaining to acute care of the individual clinical presentations. MATERIALS AND METHODS: A retrospective evaluation was carried out using all trauma-relevant ICD-10 codes for trauma to the head (S00.- to S09.-) and neck (S10.- to S19.-) among patients who were treated at the authors' clinic-a certified national trauma center-during a period of 10 years (2012 to and including 2021). RESULTS: A total of 8375 patients with head and neck trauma were treated during the observation period, i.e., an average of 836 patients per year. Within this collective, 2981 trauma cases involving soft tissue injuries were documented. Superficial injuries to the head (S00.-) and open wounds to the head (S01.-) were the most common head and neck soft tissue injuries, with 1649 and 920 cases, respectively. CONCLUSION: The case numbers of soft tissue injuries generally show an inverse correlation to the required underlying trauma: diagnoses of the categories S00 and S01 occur very often; injuries which only occur after severe trauma, such as traumatic amputation at neck level (S18), are rare. According to current literature, penetrating neck traumas should be treated using a no-zone approach. In Europe, penetrating neck injuries are rather rare because of low crime rates and strict weapon laws.

Arrowhead chronicles: A case series on arrow injuries in the head and neck region of Bhutanese archers.

Arrow injuries in Bhutan present a unique public health challenge, reflecting the cultural significance of archery in this Himalayan kingdom. Despite being a traditional sport and an integral part of Bhutanese identity, the growing incidence of arrow-related injuries raises concerns about safety and highlights the need for targeted preventive measures. In this case series, we present six cases of arrow injuries in the head and neck region offering insights into our experiences and the challenges encountered in their management. Additionally, cultural and regulatory aspects influencing archery practices and safety protocols are considered. The findings underscore the importance of community education, enhanced safety measures, and regulatory interventions to reduce the prevalence of arrow injuries while preserving the cultural heritage of archery in Bhutan. Addressing this issue necessitates a multidisciplinary approach that combines public health initiatives, cultural sensitivity, and policy interventions.

A Review of 13,470 Head and Neck Injuries from Trampoline Jumping.

Study Design: The authors designed a 20-year cross-sectional study using the National Electronic Injury Surveillance System (NEISS) database. Objective: The purpose of the study is to determine the risk factors for hospital admission among individuals who suffer head and neck injuries secondary to trampoline use. Methods: The primary predictor variables were a set of heterogenous variables that were categorized into the forementioned study variable groups (patient characteristics and injury characteristics). The primary outcome variable was hospital admission. Multivariate logistic regression was used to determine independent risk factors for hospital admission. Results: The final sample consisted of 13,474 reports of trampoline injuries to the head and neck. Relative to females, males (OR 1.66, P < .05) were at an increased risk for hospital admissions. Fractures (OR 35.23, P < .05) increased the risk for hospital admissions relative to dental injuries. Concerning anatomical region of injury, neck injuries (OR 30.53, P < .05) were at an increased risk for hospital admissions. Conclusions: Injuries to the neck from trampoline jumping significantly increased the risk for admission. The severity of neck injuries from trampoline jumping is well established in the literature. Additionally, male sex and fractures were each risk factors for hospital admission. Given the rising prevalence of trampoline-related head and neck injuries over the past 2 decades, it is crucial for individuals to take the necessary precautions when jumping on a trampoline.

Pediatric head and neck trauma in the United States: Trends, risk factors and outcomes using the National Trauma Data Bank.

Introduction: Pediatric head and neck (HN) trauma is an important contributor to pediatric morbidity, resulting in significant downstream consequences. Few studies provide epidemiological predictors of pediatric HN trauma on a national scale. The present study aims to identify risk factors of HN injury and mortality in the pediatric population. Methods: A retrospective cohort study was conducted for patients (age <18 years) using the US National Trauma Data Bank (NTDB 2007-2019). Demographic, injury, and physiologic outcome data were analyzed. HN injury was defined as a head or neck Abbreviated Injury Scale (AIS) >0. Logistic regression identified independent predictors of mortality following HN trauma. Results: Of the 1.42 million pediatric patients analyzed, 44.05% had HN injury. In patients aged 0-4, the most common mechanism was falls (47.67% in this age group) while in ages 14-17, motor vehicle/transport accidents (MVTs) were the most common mechanism (56.06%). Controlling for demographics, comorbidities, and injury severity, HN injury was associated with increased odds of mortality (OR 2.404, 95% CI 1.530-3.778). HN injury mortality was strongly predicted by firearm exposure (OR 11.28, 95% CI 6.074-20.95), age <4 (OR 1.179, 95% CI 1.071-1.299), and self-insured status (OR 1.977, 95% CI 1.811-2.157). Conclusion: NTDB data demonstrate that the percentage of pediatric patients with HN trauma has decreased over the past 12 years although is associated with increased odds of mortality. Age and insurance status predicted mortality from HN trauma, with falls and MVTs being the most common mechanisms of injury. These data have implications for future public health efforts in this patient population. Level of Evidence: 3.

Increased Incidence and Mortality of Civilian Penetrating Traumatic Brain Injury in Sweden: A Single-Center Registry-Based Study.

BACKGROUND: Penetrating trauma to the head and neck has increased during the past decade in Sweden. The aim of this study was to characterize these injuries and evaluate the outcomes for patients treated at a tertiary trauma center. METHODS: Swedish trauma registry data were extracted on patients with head and neck injuries admitted to Karolinska University Hospital (Stockholm, Sweden) between 2011 and 2019. Outcome information was extracted from hospital records, with the primary endpoints focusing on the physiological outcome measures and the secondary endpoints on the surgical and radiological outcomes. RESULTS: Of 1436 patients with penetrating trauma, 329 with penetrating head and neck injuries were identified. Of the 329 patients, 66 (20%) had suffered a gunshot wound (GSW), 240 (73%) a stab wound (SW), and 23 (7%) an injury from other trauma mechanisms (OTMs). The median age for the corresponding 3 groups of patients was 25, 33, and 21 years, respectively. Assault was the primary intent, with 54 patients experiencing GSWs (81.8%) and 158 SWs (65.8%). Patients with GSWs had more severe injuries, worse admission Glasgow coma scale, motor, scores, and a higher intubation rate at the injury site. Most GSW patients underwent major surgery (59.1%) as the initial procedure and were more likely to have intracranial hemorrhage (21.2%). The 30-day mortality was 45.5% (n = 30) for GSWs, 5.4% (n = 13) for SWs, and 0% (n = 0) for OTMs. There was an annual increase in the incidence and mortality for GSWs and SWs. CONCLUSIONS: Between 2011 and 2019, an increasing annual trend was found in the incidence and mortality from penetrating head and neck trauma in Stockholm, Sweden. GSW patients experienced more severe injuries and intracranial hemorrhage and underwent more surgical interventions compared with patients with SWs and OTMs.

Role of Dermatix in the Management of Eyelid Hypertrophic Scars After Facial Trauma.

Facial trauma can cause skin wounds with uneven and discoloured edges that require healing by secondary intention. These wounds often produce excess collagen fibres, leading to fibrosis and hypertrophic scars that can cause discomfort and negatively impact the patient's quality of life. A man suffered facial trauma due to a motor vehicle accident, resulting in a fracture of the left zygomatic-maxillary complex. He underwent surgery to fix the fracture and reconstruct his eyelid but developed a hypertrophic scar during recovery that caused eye dryness and discomfort. To treat the scar, Dermatix silicone gel (SG) (Viatris, Canonsburg, PA) was applied twice a day. After two months of treatment, the scar had improved significantly, and the patient's eyelid function had also improved. This case describes the use of Dermatix SG to treat a patient with a traumatic hypertrophic scar of the eyelid associated with eyelid malposition. Silicone gel is a non-invasive treatment for scars and has been shown to be effective in reducing scar elevation and erythema. However, there is a gap in the literature regarding the routine use of SG to preserve functionality and aesthetics in traumatic hypertrophic scars of complex anatomical structures. Further studies are needed to understand the principles of using SG for these types of scars to improve functional and aesthetic outcomes. Applying Dermatix SG twice a day for 60 days corrected a patient's functional and aesthetic issues. More studies should be conducted to investigate the product's effectiveness further.

Carotid-Threatening Penetrating Oropharyngeal Trauma in a Pediatric Patient: A Case Report and Literature Review.

Penetrating oropharyngeal injury is a relatively common occurrence in pediatric patients; however, cases involving close proximity to critical vascular structures, such as the internal carotid artery (ICA), are exceedingly rare and pose significant risks. This case report describes a seven-year-old male who sustained penetrating oropharyngeal trauma with startling proximity to the ICA after being pushed into a locker with a pencil in his mouth. Initial evaluation showed the wooden pencil protruding from the soft palate without active bleeding. CT angiography revealed that it was less than 1 mm from the left ICA, with no signs of extravasation or dissection. The pencil was removed atraumatically under ketamine sedation, and the puncture site was irrigated without complications. In patients presenting with penetrating oropharyngeal trauma, injury to the internal carotid or adjacent vessels with possible resulting extravasation or dissection should be considered. This is a single case report accompanied by a literature review.

Penetrating Head and Neck Trauma: A Narrative Review of Evidence-Based Evaluation and Treatment Protocols.

Penetrating injury to the head and neck accounts for a minority of trauma but significant morbidity in the US civilian population. The 3-zone anatomical framework has historically guided evaluation and management; however, the most current evidence-based protocols favor a no-zone, systems-based approach. In stable patients, a thorough physical examination and noninvasive imaging should be prioritized, with surgical exploration of the head and neck reserved for certain circumstances. Diagnostic and management decisions should be tailored to the mechanism of injury, history, physical examination, experience of personnel, availability of equipment, and clinical judgment.

Neuroendovascular Surgery Applications in Craniocervical Trauma.

Cerebrovascular injuries resulting from blunt or penetrating trauma to the head and neck often lead to local hemorrhage and stroke. These injuries present with a wide range of manifestations, including carotid or vertebral artery dissection, pseudoaneurysm, occlusion, transection, arteriovenous fistula, carotid-cavernous fistula, epistaxis, venous sinus thrombosis, and subdural hematoma. A selective review of the literature from 1989 to 2023 was conducted to explore various neuroendovascular surgical techniques for craniocervical trauma. A PubMed search was performed using these terms: endovascular, trauma, dissection, blunt cerebrovascular injury, pseudoaneurysm, occlusion, transection, vasospasm, carotid-cavernous fistula, arteriovenous fistula, epistaxis, cerebral venous sinus thrombosis, subdural hematoma, and middle meningeal artery embolization. An increasing array of neuroendovascular procedures are currently available to treat these traumatic injuries. Coils, liquid embolics (onyx or n-butyl cyanoacrylate), and polyvinyl alcohol particles can be used to embolize lesions, while stents, mechanical thrombectomy employing stent-retrievers or aspiration catheters, and balloon occlusion tests and super selective angiography offer additional treatment options based on the specific case. Neuroendovascular techniques prove valuable when surgical options are limited, although comparative data with surgical techniques in trauma cases is limited. Further research is needed to assess the efficacy and outcomes associated with these interventions.

The Most Dangerous Game: A Review of Head and Neck Injuries in American Football and Rugby.

Study Design: The investigators designed and implemented a 20-year cross-sectional study using the National Electronic Injury Surveillance System database. Objective: The purpose of this study is to estimate and compare hospital admission (danger) rates between rugby and football of those who presented to the emergency department with head and neck injuries after playing these sports. Methods: The primary predictor variable was sport played. The primary outcome variable was danger, measured by hospital admission rates. Results: Over the past 20 years, there has been a trend of decreasing incidence of injuries presenting to the emergency department in both sports. There was no difference in the rate of hospital admission when comparing football and rugby (OR, 1.2; P = .1). Male gender was associated with an increased risk of admission. Other variables associated with hospital admission included white racial group, injury taking place in the fall, being either young (15-24 years old) or senior (65 years of age and over), and being injured at school or at a sport/recreational facility. Conclusions: There is no difference in danger as measured by admission rates between American football and rugby. There exists, however, several variables that are associated with admission when sustaining injury to the head and neck, when playing these two sports.

A Rare Isolated Hyoid Bone Fracture: A Case Report and Review of the Literature.

Isolated hyoid bone fractures are rare and account for a small percentage of all head and neck fractures. The anatomic location of the hyoid bone, which is between the jaw and the cervical spine, is its most essential protective mechanism. In addition to the anatomic protection provided by the mandible, the fusion of the hyoid's bone pieces and the bone's mobile capacity in all directions are other protective factors contributing to the rarity of these fractures. However, this defense mechanism can get compromised upon exposure to blunt traumas and hyperextension injuries. Injury to the neck by blunt trauma can induce fast deterioration, and a missed or delayed diagnosis can result in morbidity and fatality. The importance of early diagnosis and suggested management options are further discussed. We herein report an unusual case of an isolated hyoid bone fracture in a 26-year-old man who was hit by a car while crossing the street. The patient was otherwise asymptomatic and vitally stable so he was managed successfully by conservative management only.

Delayed Lower Motor Neurone Facial Nerve Palsy Following a Traumatic Head Injury.

Delayed facial nerve weakness secondary to head injury is rare. The mechanism of immediate facial nerve paralysis is obvious, however, the delayed presentation remains disputed. We report a 58-year-old gentleman who presents 6 days after being discharged following head trauma with a 2-day history of facial nerve paralysis (House-Brackmann grade 6). Computed tomography (CT) head showed a minimally displaced longitudinal squamous temporal bone fracture initially with nerve conduction studies and electromyograpy revealing a relative reduction in left facial motor amplitudes with moderate recruitment. He showed good progress following high-dose steroids and conservative management. Early involvement of ear, nose and throat (ENT) surgeons is crucial. The use of both high-resolution CT scanning and nerve conduction studies will help guide management as early as possible and improve outcomes in these patients.

Pneumorrhachis Following Neck Penetrating Injury: A Case Report.

The development of air in the spinal canal is an uncommon and usually asymptomatic event. Also known as pneumorrhachis (PNR), the main information about this phenomenon is based on a few case reports published previously. It is highly difficult to identify this entity clinically, and in most publications, PNR was incidentally identified during image procedures, mainly computed tomography (CT) scans. With the advancement of technology and the development of guidelines for the treatment of penetrating and neck injuries, the number of PNR diagnosis has increased. It is also a common agreement among the articles reviewed that the least common cause of PNR is traumatic events. This report presents a rare case of pneumorrhachis as a consequence of a penetrating neck injury. The studied patient was a 27-year-old female with multiple stab wounds on the left posterior side of the neck and left shoulder, thereby developing left-side body weakness as a consequence of the wound. The patient was immediately evaluated and managed by the emergency team, and as the patient was vitally stable, she was shifted to an urgent CT scan. CT scan showed subarachnoid air focus, multiple extradural air foci, and spinal cord injury on the cervical spine. This patient was treated conservatively, but her neurological symptoms persisted until discharge.

Head and Neck Injury Patterns among American Football Players.

IMPORTANCE: American football is a popular high-impact sport, leading to 2.7 million injuries in the United States annually. Recent evidence in football-related neurological damage has spurred national interest in player-safety. Football players injure their head and neck in up to 26% of total injuries. Variation in injury patterns between age groups and correlated hospitalizations for football-related head and neck injury has yet to be characterized. OBJECTIVE: Our aim is to evaluate injury patterns among American-football related head and neck trauma. METHODS: A retrospective cohort study of patients with football-related head and neck injury in the National Electronic Injury Surveillance System (NEISS). RESULTS: Nearly 100 000 ED visits for football-related head and neck injuries occur annually. Males comprised 95% of patients, with a median age of 13. The head comprised 70% of injuries followed by the face (13%). The most common diagnoses were concussions (39%), internal organ injury (26%), and lacerations (11%). Pediatric patients were more likely to sustain concussions while adults experienced more lacerations (P < .05%). Fractures and nerve damage were rare injuries but caused a disproportionate share of hospitalizations. CONCLUSION: Pediatric males are most likely to present for emergency care from football-related injury to the head and neck. Evaluating physicians can anticipate concussions, internal organ injury, and lacerations among presenting patients. Concussions, facial fractures, and nerve damage are injuries most likely to lead to hospitalization.

Acute Basilar Artery Occlusion and Death Secondary to Bilateral Vertebral Artery Dissection.

Vertebral artery dissection as a cause of basilar artery thrombosis is an exceedingly rare event that is associated with significant morbidity and poor outcomes. We present an unusual case of bilateral vertebral artery dissection and spinal cord compression in a 21-year-old male involved in a diving accident. The patient received limited antithrombotic therapy in pursuit of surgical spinal decompression, ultimately contributing to thrombosis of the basilar artery in the post-operative period and death following anterior cervical discectomy and fusion. Our goal is to highlight the severity of vertebral artery injury and the critical importance of treatment in the prevention of associated sequelae.

Evaluation of Banana Leaves (Musa paradisiaca) as an Alternative Wound Dressing Material Compared to Conventional Petroleum Jelly Gauze Dressing in Contused, Lacerated and Sutured Wounds Over the Head, Neck and Face Region.

Aim To evaluate the effectiveness of banana leaf dressing in patients with contused, lacerated and sutured wounds over the head, neck and face region with respect to pain during dressing change, patient comfort, status of wound bed during dressing change and handling characteristics in comparison with petroleum jelly gauze dressing. Methods and materials Sixty patients were included, out of which 30 patients were used as controls with petroleum jelly gauze dressings and 30 patients as study participants with banana leaf dressings. Pain on dressing change, handling characteristics of dressing material, patient comfort and status of wound bed on every dressing change were assessed. Results Properties of both banana leaves and petroleum jelly gauze dressings were parallel in all aspects, except pain on dressing change which was less with banana leaf dressings and had statistically significant value (p>0.001). Conclusions Banana leaves (Musa paradisiaca) can become an alternative choice of wound dressing material in contused, lacerated and sutured wounds over the head, neck and face region as they proved to cause less pain and trauma during dressing change and have other advantages such as cost and availability, comfort and ease of handling the dressing by health professionals.

An Unusual Case of Ludwig's Angina Following Mandibular Fracture.

The mandible is the most commonly fractured bone in the maxillofacial region following trauma. Severe infections are rare, and so we highlight an unusual presentation of Ludwig's angina following a late presentation of a mandibular fracture in a 68-year-old gentleman with significant medical co-morbidities. The recovery process was prolonged and involved multi-disciplinary input. This case makes a recommendation for early recognition of mandibular fractures, antibiotic therapy where appropriate, and hypervigilance when caring for patients with systemic illnesses.

Combined Pharyngeal Laceration and Laryngeal Fracture Secondary to Dog Bite: A Case Report.

Dog bites are the most common animal bites, typically occurring in the head and neck region or extremities. The majority of dog bite-related injuries are superficial and require minimal medical intervention. Less commonly, dog bite injuries can be very serious when involving the airway, major blood vessels, or extensive tissue loss. To this day, there are very few case reports in the medical literature that describe severe dog bites and outline their management. We present a case of successfully treating an extensive pharyngeal laceration with a laryngeal cartilage fracture produced by an unvaccinated dog bite.

Traumatic Injury of Major Cerebral Venous Sinuses Associated with Traumatic Brain Injury or Head and Neck Trauma: Analysis of National Trauma Data Bank.

BACKGROUND: The natural history and epidemiological aspects of traumatic injury of major cerebral venous sinuses are not fully understood. We determined the prevalence of traumatic injury of major cerebral venous sinuses and impact on the outcome of patients with traumatic brain injury, and/or head and neck trauma. METHODS: All the patients who were admitted with traumatic brain injury or head and neck trauma were identified by ICD-9-CM codes from the National Trauma Data Bank (NTDB), using data files from 2009 to 2010. NTDB represents one of the largest trauma databases and contains data from over 900 trauma centers across the United States. Presence of thrombosis, intimal tear, or dissection (traumatic injury) of major cerebral venous sinuses was identified in these patients by using Abbreviated Injury Scale predot codes. Admission Glasgow Coma Scale (GCS) score, Injury Severity Score (ISS), In-hospital complications, and treatment outcome were compared between patients with and without traumatic injury of major cerebral venous sinuses. RESULTS: A total of 76 patients were identified with traumatic injury of major cerebral venous sinuses among 453,775 patients who had been admitted with head and neck trauma. The rate of penetrating injury was higher among patients with traumatic injury of major cerebral venous sinuses (11.8% versus 2.5%, p = 0.0001). The patients with traumatic injury of major cerebral venous sinuses had a significantly higher rate of intracranial hemorrhage in comparison to patients without traumatic injury of major cerebral venous sinuses. The odds of in-hospital mortality remained significantly higher for patients with traumatic injury of major cerebral venous sinuses after adjusting for age, gender, admission GCS score, ISS injury type, and presence of intracranial hemorrhage [odds ratio (OR): 6.929; 95% confidence interval (CI) 1.337-35.96; p < 0.020]. The odds of discharge to nursing home remained higher for patients with traumatic injury of major cerebral venous sinuses after adjusting for potential confounders (OR: 1.8401; 95% CI 1.18-2.85, p < 0.0065). CONCLUSION: Although infrequent, traumatic injury of major cerebral venous sinuses in head and neck trauma is associated with higher rates of in-hospital mortality and discharge to a nursing home.

Contact sport related head and neck injuries in pediatric athletes.

OBJECTIVES: To describe the type and frequency of sports related pediatric head and neck trauma. METHODS: The National Electronic Injury Surveillance System (NEISS) was searched for football, basketball, soccer, lacrosse and ice hockey related facial injuries. Cross-sectional analysis of incidence, age, and sex and specific injury diagnoses, mechanisms, and facial locations were performed. We focused on craniofacial and soft tissue injuries and excluded patients with concussion or other neurological injuries. RESULTS: A total of 24,905 cases were identified in the NEISS database, corresponding to an estimated, 764,293 emergency department visits. The most hazardous sports were basketball, accounting for 356,188 visits (46.6%), football with 249,633 visits (32.6%), and soccer with 128,113 (14.7%) visits. Lacrosse and ice hockey accounted for 16,869 (1.9%) and 13,490 (1.5%) visits, respectively. There has been a decrease in injuries over the past 10 years, particularly for football (53%), ice hockey (46%), and lacrosse (41%). Soccer (13%) and basketball (9%) noticed the smallest decreases. CONCLUSION: Children who play basketball, football and soccer are especially prone to emergency department visits related to the head and neck. Overall, there has been an improvement in number of injuries across the five sports investigated. Sports amenable to head and neck protective equipment saw the largest improvement (football, ice hockey, lacrosse), whereas only small decreases were noted in basketball and soccer. Changes in regulations for sports not amenable to more protective equipment may help decrease adverse events.