Neck Trauma

Question 1

What are the 3 zones of the neck bounded by? (3)

Answer 1

Zone 1 = suprasternal notch/clavicles to cricoid cartilage
Zone 2 = cricoid to angle of mandible
Zone 3 = angle of mandible to base of skull

Question 2

What structures are in zone 1 of the neck? (10)

Answer 2

Common carotid a.
Vertebral a.
Subclavian a.
Upper mediastinal vessels
Lung apices
Esophagus
Trachea
Thyroid
Throacic duct
Spinal cord

Question 3

What structures are in zone 2 of the neck? (10)

Answer 3

Common carotid a.
Vertebral a. 
Jugular vein
Laryngx
Pharynx
Esophagus
Trachea
Vagus n.
Recurr laryngeal n.
Spinal cord

Question 4

What structures are in zone 3 of the neck? (7)

Answer 4

Distal carotid a.
Vertebral a.
Distal jugular vein.
Salivary glands
Parotid glands
Cranial N. IX - XII
Spinal cord

Question 5

Name the layers of fascia in the neck (4)? Which is particularly important any why? (1)

Answer 5

Superficial + Deep
Deep --> 1) investing
               2) pretracheal
               3) prevertebral
Pretracheal important as connects neck to mediastinum and if injured, missed aerodigestive injuries can lead to mediastinitis

Question 6

What is the platysma muscle and why does in matter?

Answer 6

Is broad bilateral muscle just lateral to midline of the neck – superficial, broad sheath over the sternocleidomastoids.
– lies between superficial + deep fascia.

If injuried suspect deep neck injuries (ie. used to separate unimportant superficial injuries from possible deep injuries)

Question 7

What are the HARD signs of neck injury? (10)

Answer 7

• Pulsatile / expanding hematoma
• Air bubbling
• Massive hemoptysis
• Shock NRT fluids
• Severe hemorrhage
• Decreased/absent radial pulse
• Vascular bruit/thrill
• Stridor/hoarseness/airway compromise
• Cerebral ischemia
• Massive subcut emphysema