A 30-year-old man sustains a stab wound to zone II of the neck (between the cricoid cartilage and the angle of the mandible). He is haemodynamically stable, the wound does not appear to violate the platysma, and there is no active haemorrhage. Appropriate initial management is:
- A CT angiography of the neck to evaluate vascular and aerodigestive structures, then selective surgical exploration based on findings ✓
- B Immediate surgical exploration of zone II regardless of haemodynamic stability
- C Observation alone if wound is superficial to the platysma
- D Rigid bronchoscopy and oesophagoscopy as the first investigation
Correct answer: A. CT angiography of the neck to evaluate vascular and aerodigestive structures, then selective surgical exploration based on findings
Explanation
Modern management of penetrating neck trauma has shifted from mandatory surgical exploration to a selective, CT angiography-guided approach in haemodynamically stable patients. CT angiography can rapidly evaluate vascular, airway, and oesophageal injuries; surgical exploration is then targeted based on findings. Zone II (between cricoid and angle of mandible) is most commonly injured and most accessible surgically, but CT-guided selection avoids unnecessary negative explorations.
Reference: Bailey & Love's Short Practice of Surgery, 27th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.