title: Penetrating neck injury from a screwdriver: can the No Zone approach be applied to Zone I injuries?
abstract: The newer approach to management of penetrating neck injuries (PNI) involves the No Zone approach: comprehensive physical examination combined with CT angiography for triage to effectively identify or exclude vascular and aerodigestive injury. This approach, however, has a low negative exploration rate; there is risk of missing occult injuries especially Zone I and III PNI. We report a case of a patient with PNI to Zone I of the neck who was haemodynamically stable at presentation; CT scan revealed complete occlusion of the common carotid artery. Immediate surgical exploration revealed an occult hypopharyngeal injury in addition to the arterial trauma, which was missed on the CT scan. Hence the No Zone approach needs cautious clinical application, especially in Zone I injuries.
authors.affiliation: Department of Surgery, University Hospital Waterford, Waterford, Ireland Department of Surgery, University Hospital Limerick, Limerick, Ireland.
authors.forename: Nikita R
authors.initials: NR
authors.lastname: Bhatt
authors.affiliation: Department of Surgery, University Hospital Waterford, Waterford, Ireland.
authors.forename: Morgan
authors.initials: M
authors.lastname: McMonagle
mesh_terms: D000792:Angiography; D001157:Arterial Occlusive Diseases / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery; D020212:Carotid Artery Injuries / Q000000981:diagnostic imaging* / Q000601:surgery; D017536:Carotid Artery, Common / Q000000981:diagnostic imaging* / Q000601:surgery; D006406:Hematoma / Q000000981:diagnostic imaging / Q000209:etiology; D006801:Humans; D007013:Hypopharynx / Q000000981:diagnostic imaging / Q000293:injuries* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D019838:Neck Injuries / Q000000981:diagnostic imaging* / Q000601:surgery; D013927:Thrombosis / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery; D014057:Tomography, X-Ray Computed; D014218:Triage / Q000379:methods*; D014950:Wounds, Penetrating / Q000000981:diagnostic imaging* / Q000601:surgery