Penetrating Neck Trauma: Diagnostic Studies in the Asymptomatic Patient

The selective management of penetrating neck trauma implies an attempt to individualize care and minimize unnecessary surgical exploration. In asymptomatic patients, diagnostic studies are performed in an attempt to exclude clinically unrecognized injuries. This review of 100 consecutive cases of penetrating neck trauma assesses the role of ancillary diagnostic studies in 53 patients selectively managed. The diagnostic yield from a combination of angiography, fluoro-esophagography, and aerodigestive tract endoscopy was 22.6% (12 of 53). However, only five patients (9.4%) actually benefitted from ancillary diagnostic studies, in that angiography documented clinically unrecognized injury. In an effort to avoid the indiscriminate use of ancillary diagnostic studies, a selective management plan based on anatomic zones of injury is provided.