A 22-year-old man with a stab wound to zone III of the neck (above the angle of mandible) presents with active arterial bleeding from the carotid territory. Which management strategy is preferred over open exploration for zone III injuries?

• A Immediate open surgical exploration via anterior cervical incision
• B Endovascular management (covered stent or balloon occlusion) via angiography ✓
• C External carotid ligation as definitive treatment
• D Conservative management with close observation

Explanation

Zone III neck injuries (above the angle of mandible to the base of skull) are surgically inaccessible via standard cervical incisions due to the proximity of the skull base. Endovascular interventions — including covered stent placement, coil embolisation of bleeding vessels, or balloon tamponade — are preferred for vascular injuries in this zone. Zone I (below cricoid) also favours angiographic evaluation. Zone II injuries (cricoid to angle of mandible) are surgically accessible and amenable to direct exploration.

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.