Injuries to the head and neck region may occur through a variety of different mechanisms, including motor vehicle accidents, assault, workplace accidents, sporting or recreational activities, or falls. Injuries may involve the bone or soft tissues of the head and neck, and may pose risk to the major blood vessels of the neck, the swallowing passage, or airway and voicebox. With any injury to the head and neck area, a thorough evaluation by a trauma team is necessary to assess for life threatening injuries to the brain, spinal cord, or airway. Otolaryngologist - head and neck surgeons assist the trauma team in the management of injuries to the facial skeleton and soft tissues, swallowing passage, and airway.
Injuries to the facial skeleton
Bony injuries to the facial skeleton may through a variety of different mechanisms. While such fractures may lead to changes in facial appearance, they may also lead to impairment of vision, nasal blockage, changes in dental occlusion, and even leakage of spinal fluid with risk of meningitis. Evaluation for bony injuries requires both a thorough examination, with focus on the function of the major nerves of the face and neck, vision and eye movement, and alignment of the teeth. Xrays, most often a CT scan, are usually also obtained depending on the severity of the injury and the examination findings. The most common bones fractured are the nasal bones. Such fractures can often be reset without need for incisions. Most fractures of the upper jaw (maxilla), eye socket (orbit), or forehead area (frontal bone) require an open surgical repair. Repair of lower jaw (mandible) fractures usually requires the jaws to be wired temporarily shut to assure proper alignment of the teeth after healing.
Injuries to the facial soft tissues
Lacerations of the facial tissues may occur after blunt or penetrating traumatic injuries. This may vary from superficial abrasions of the skin, to deep lacerations requiring suture repair, to severe injuries involving skin, muscle and even nerves of the face. Less extensive injuries may often be treated under local anesthesia in the office or emergency room setting. More extensive injuries may need to be addressed in the operating room under anesthesia.
Injuries to the breathing and swallowing passages
Either blunt or penetrating injuries to the neck may result in injury to the breathing or swallowing passages. When such injuries are suspected, the initial trauma evaluation will include assessment of the breathing passage, or airway, as compromise of the airway can be life threatening. Symptoms of injury to the airway, including the windpipe or trachea, and the voicebox or larynx, include noisy breathing, voice change, coughing blood, bruises on the neck, or air under the skin. Assessment may include an examination of the breathing passage with an endoscope, and a CT scan of the cartilages of the airway. In the event of such injuries a breathing tube may be temporarily needed to assure an adequate breathing passage while this and other injuries are treated. Treatment of airway injuries varies from close monitoring and medications to reduce swelling in the airway, to surgery directed at repairing damaged cartilage in the trachea or larynx. Injuries to the swallowing passage, including the throat or pharynx, and the esophagus, may lead to similar symptoms as airway injuries. Evaluation may include endoscopy, and also a barium swallow. Treatment varies with the extent of injury, and may consist of temporary placement of a feeding tube to allow the injured area to heal, or open surgery to repair a large tear in the pharynx or esophagus.
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