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visualization or surgical intervention may be required. When acute airway
management is not a concern, the aim is to identify which patient with minimal or
no symptoms warrants advanced imaging and/or surgical consultation to avoid
missing injuries to these critical structures that have the potential to progress (see
Chapter 112 Neck Trauma for further details).
CLINICAL PEARLS AND PITFALLS
Patients with blunt trauma to the anterior neck should also be
evaluated for cervical spine injury.
Any patients with penetrating injuries to the central third (i.e., zone 2) of
the neck should be considered for surgical exploration even if stable.
Patients with penetrating injuries to zones 1 and 3 of the neck should
initially undergo MRA/MRV to assess for vascular injury prior to other
interventions including exploration.

Current Evidence
Blunt trauma can cause mucosal lacerations, hematomas, vocal cord injury, or
fractures of the bony or cartilaginous larynx and trachea. Penetrating trauma
results in additional risk to the airway and vasculature, as covered in Chapter 112
Neck Trauma .

Clinical Considerations
Clinical Recognition
Blunt injuries to the neck often present with neck pain, hoarseness, cough, or
hemoptysis. Some patients may have relatively mild symptoms despite injury.
Neck swelling, or visible injury such as ecchymosis and abrasions may be
identified on examination.
Triage
Patients with significant respiratory distress or penetrating injuries to the neck
should be emergently evaluated and surgical specialty consultation pursued.
Those without acute compromise of the airway, breathing, or circulation should
be seen expeditiously and monitored frequently for clinical deterioration.