Timely management of penetrating neck trauma: Report of three cases
A 53-year-old male was admitted to our emergency room with a deep stab wound in his neck after attempting suicide. The wound started to the left of the medial head of the sternocleidomastoid muscle and continued horizontally to the right of the medial head of the right sternocleidomastoid []. The laceration was at the level of the lower third of the thyroid cartilage. The wound continued deep into the larynx. The thyroid cartilage was cut horizontally and away from the supraglottic region, and the damage continued to the hypopharynx and ended anterior to the prevertebral mucosa []. When initially examined in the emergency room, he was in moderate respiratory distress. There was no massive bleeding. His larynx was obviously badly damaged. Shortly after admission, he developed respiratory distress and started bleeding, preventing a radiological examination. We did not attempt orotracheal or nasotracheal intubation because of the badly damaged larynx. Under local anesthesia, we made a tracheotomy and then induced general anesthesia. Using his self-inflicted wound, when we dissected the neck, we saw that the thyroid ala, both laryngeal ventricles, and the lower third of the epiglottis were cut horizontally. The supraglottic and infraglottic regions were separated horizontally. We consulted a vascular surgeon in the operating room. The patient has no significant carotid or venous injuries, although there were some minor venous injuries. We reconstructed all of the damaged structures and sutured the sinus piriformis mucosa, epiglottis petiole, and thyroid cartilage alae. We used Prolene sutures to reconstruct the epiglottic and thyroid cartilages. After 5 days’ follow-up, he was transferred to the psychiatric ward. We closed his tracheotomy after 3 months. He has not had any voice, swallowing, or breathing problems since his tracheotomy was closed. There is some residual damage to the epiglottis on the right side [].\nWe gave all patients second-generation antibiotics for surgical prophylaxis. After 5 days’ follow-up, the first and second patients were discharged without any complications.