Penetrating neck trauma (mechanism of disease)

This is a flowchart on penetrating neck trauma, covering the etiology, pathophysiology, and manifestations.
ADDITIONAL TAGS:
Risk factors / SDOH
Cell / tissue damage
Structural factors
Medicine / iatrogenic
Infectious / microbial
Pressure physiology
Immunology / inflammation
Signs / symptoms
Tests / imaging / labs
Environmental / exposure
Cancer / neoplasm
Flow physiology
Pathophysiology
Etiology
Manifestations
Thrusting action of a pointed object (e.g., knife, broken bottle)
Tissue is lacerated and torn along the path of the object
Stab wounds:
Depth of injury usually greater than the width
Tissue is lacerated and crushed along the path of the bullet
Gun shot wounds:
Tissue displaced forward and radially → cavitation and pressure injury of nearby structures.
Dense organs (liver, bone) absorb more kinetic energy than less dense organs, resulting in greater injury
Severity of injury is related to the kinetic energy of the bullet (i.e., weight, velocity)
Penetrating neck trauma
Penetrating neck trauma
Tracheobronchial injury
Esophageal injury
Vascular injury: carotid artery, vertebral artery, jugular vein)
Cranial nerve injury:
Pneumothorax: air enters pleural cavity → lung collapse
Airway compromise
Wound bubbling
Extensive subQ emphysema
Hoarseness, stridor
Hemoptysis, hematemesis
Dysphonia (abnormal voice)
Mild subQ emphysema
Dysphagia
Hard signs → requires surgical intervention often bypassing CT imaging
Soft signs → requires CTA for further evaluation
Hemorrhagic shock (hypotension, tachycardia)
Pulsatile bleeding
Expanding hematoma
Carotid bruit
Hard signs
Unilateral pulse deficit
Signs of stroke
Minor bleeding
Soft signs
Non-expanding hematoma
Proximity wound
Vagus nerve palsy
Recurrent laryngeal nerve palsy
Flaccid paralysis of the soft palate
Nasal speech
Dysphagia, aspiration
Postprandial bloating
Gastroparesis
Chest pain
Respiratory distress; hypoxia; ↓ or absent breath sounds
Distended neck veins, tracheal deviation
Tension pneumo.
Obstructive shock
Progressively ↑ pressure within chest
Bilateral → Aphonia, inspiratory stridor
Unilateral → Dysphonia, hoarseness