Grave Prognosis of Penetrating Neck Trauma: A Case Report

Neck trauma management is still challenging even for experienced physicians. Stable-appearing patients may strike vascular, laryngeal or neurologic complications. Here, a patient with neck stab wound and airway compromise was discussed.
Case Description: A 28-year-old conscious man was admitted to hospital one hour after an assault with a knife stab wound on the mid-superior border of right trapezoid muscle in zone II of his neck. Patient suffered from a 1 cm sharp deep wound with local emphysema but without obvious bleeding. His general condition was satisfactory and stable in the first 6 hours of admission. Computed Tomography angiography showed air in subcutaneous tissue with no injuries to great vessels and hematoma. Unfortunately, the patient began to smoke cigarette without permission and he complained the emission of smoke from his neck wound. He then, exhibited hoarseness without stridor and still no other signs were present.
To investigate possible airway injuries, patient underwent flexible bronchoscopy during which, the entrance wound below the larynx was found before respiratory distress occurred. His respiratory conditions became stable in ICU.
Neck CT angiography is reported helpful in order to investigate the neck stab wound as well as to determine the need for invasive procedures in patients with stable condition. Non-destructive upper airway injuries could be managed conservatively with careful patient clinical observation. Consultation with an anesthesiologist or ear, nose, and throat specialist for potential airway injury would be helpful.