title: Anthropometric assessment of cervical neurovascular structures using CTA to determine zone-specific vulnerability to penetrating fragmentation injuries.
abstract: OBJECTIVE
  To determine military-specific cervical neurovascular and external anthropometric data to scale future numerical injury models of the neck and improve body armour design with a view to prevention or mitigation of combat neck injury.
  
  
  METHODS
  Contrast-enhanced computed tomography (CT) angiograms of 50 UK servicemen were analysed. Mean diameters and distances from the skin surface were determined for the carotid artery (CA), internal jugular vein (IJV), vertebral artery (VA) and spinal cord (SC) at the three surgical neck zones. Horizontal neck circumference at C6 and three potential vertical cervical anthropometric measurements were analysed to determine which had the least variability between subjects.
  
  
  RESULTS
  The diameters of cervical vascular structures are greater and the vessels more superficial as the anatomical plane moves caudally. The SC and VA are better protected than the IJV and CA due to their greater depth and bony coverage, except for the VA in zone 1.
  
  
  CONCLUSIONS
  Future cervical anthropometric assessments should use the vertical angle of mandible to mid-claviclular distance in combination with the horizontal neck circumference as these demonstrated the least variability. Cervical neurovascular structures are least vulnerable posterosuperiorly and therefore extending the posterior aspect of a ballistic helmet inferiorly or adding a nape protector would appear to be less justified. Cervical vessels are most vulnerable in zone 1 and a circumferential collar of ballistic material at least 75 mm high would cover this area in 95% of this population.
authors: Academic Department of Military Surgery and Trauma, Royal Centre for Defence Medicine, Birmingham, UK. johnobreeze@doctors.org.uk
authors: J
authors: J
authors: Breeze
authors: A
authors: A
authors: West
authors: J
authors: J
authors: Clasper
mesh_terms: D000328:Adult; D000886:Anthropometry; D002339:Carotid Arteries / Q000000981:diagnostic imaging; D020212:Carotid Artery Injuries / Q000000981:diagnostic imaging / Q000517:prevention & control; D003287:Contrast Media; D004867:Equipment Design; D006801:Humans; D007601:Jugular Veins / Q000000981:diagnostic imaging; D008889:Military Personnel; D019838:Neck Injuries / Q000000981:diagnostic imaging / Q000517:prevention & control*; D011481:Protective Clothing; D013116:Spinal Cord / Q000000981:diagnostic imaging; D013119:Spinal Cord Injuries / Q000000981:diagnostic imaging / Q000517:prevention & control; D014057:Tomography, X-Ray Computed / Q000379:methods; D020196:Trauma, Nervous System / Q000000981:diagnostic imaging / Q000517:prevention & control*; D057772:Vascular System Injuries / Q000000981:diagnostic imaging / Q000517:prevention & control*; D014711:Vertebral Artery / Q000000981:diagnostic imaging; D014950:Wounds, Penetrating / Q000000981:diagnostic imaging / Q000517:prevention & control*
chemical_list: D003287:Contrast Media