You have been called to the Emergency Department to review a previously well adult male who has sustained a penetrating injury to the root of the neck.
a) Describe the anatomy of the root of the neck on the left side describing the clinically important
structures that may be injured. (50% marks)
b) Outline the issues specific to management of a penetrating neck injury. (50% marks)
a)
The root of the neck is the junction between the thorax and the neck. It opens into, and is the cervical side of, the superior thoracic aperture, through which pass all structures going from the head to the thorax and vice versa
The root of the neck is bound laterally by the first rib, anteriorly by the manubrium, and posteriorly by the T1 vertebrae.
From anterior to posterior, the major contents are:
b)
Examiners Comments:
Generally, poorly answered. Limited knowledge of anatomy and poor structure to answers. A broad approach with a logical approach to prioritisation of investigations/treatments was all that was required to score well. Few candidates commented on general principles of complex trauma requiring input from multiple teams.
This queestion is identical to Question 7 from the second paper of 2015, except this time you have been called to the Emergency Department, not the Emergency Room. Again, the pass rate was under 30%. For future reference, neck anatomy and penetrating neck injury is described in excellent detail by Phillip Thorek in his chapter for Anatomy in Surgery (1985) which is unfortunately paywalled by Springer. So is "Trauma to the neck region" by Saletta et al (1973) and the UpToDate article on penetrating neck injury. For the freegan, Karim Brohi's 2002 write-up of neck wounds on trauma.org is of a high quality.
Brohi divides the neck into three zones, each with its own specific concerns:
(image from trauma.org)
Zone 1:
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Zone 2 Extends from the cricoid cartilage to the angle of the mandible.
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Zone 3 Extends from the angle of the mandible to the mastoid process.
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Specific concerns:
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Specific concerns:
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Specific concerns:
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So, this question is about Zone 1, where all the important stuff is.
b)
A generic approach to management:
Reasons for urgent surgical exploration:
Additional concerns specific to the root of the neck:
Thorek, Philip. "Root of the Neck." Anatomy in Surgery. Springer, New York, NY, 1985. 247-251.
Saletta, John D., Frank A. Folk, and Robert J. Freeark. "Trauma to the neck region." Surgical Clinics of North America53.1 (1973): 73-86.