THE ROLE OF CAREFUL AIRWAY ASSESSMENT IN PENETRATING NECK INJURY

Abstract

➢ Introduction Penetrating neck injuries are potentially fatal due to the presence of major vascular and aerodigestive structures. Airway management remains a priority, however, not all patients require immediate tracheostomy. In a patient who is clinically stable, examination under anaesthesia (EUA) with airway intervention performed under controlled setting in the operation theatre may be a safe alternative. ➢ Report A 25 year-old male presented with a penetrating neck injury following a trauma at his workplace. On presentation, the patient was hemodynamically stable with no stridor, respiratory distress or oxygen desaturation. Clinical examination revealed a penetrating neck wound involving the inferior part of thyroid cartilage and cricoid. Due to stable airway status, the patient is monitored closely and proceeded for tracheostomy under local anaesthesia, wound exploration and laryngeal cartilage repair in the operating theatre. The patient recovered well post operation and subsequently decannulated after 1 month. ➢ Discussions Penetrating neck injuries remain controversial and range from immediate tracheostomy, endotracheal intubation, selective conservative observation, to operative exploration and repair depending on airway status and injury severity. Traditionally, tracheostomy is considered in suspected airway injury. However, not all penetrating neck injuries require immediate surgical intervention. In clinically stable patients, EUA and definitive airway management may be safely performed in a controlled operative setting, avoiding unnecessary tracheostomy-related morbidity. This case highlights the importance of individualised airway management in penetrating neck trauma. ➢ Conclusions Not all penetrating neck injuries require immediate tracheostomy. Careful airway assessment and close monitoring are crucial in determining the need for surgical airway intervention. In selected stable patients, controlled operative evaluation may provide safe and effective outcomes.