A Rare and Challenging Case : Trident Injury to the Neck

Abstract

Introduction :

Penetrating neck trauma though rare (5-10 % of all trauma cases) carries a high degree of morbidity and mortality. They not only pose a challenge to the surgical team but also to the anesthesia team with respect to securing the airway and induction of general anesthesia.

Case Report :

We report a case of a 9 year old male child who presented with penetrating neck trauma with a metallic trident. Clinically the child was stable and had no signs and symptoms of potential neurovascular injury. Xray examination in antero-posterior and lateral views revealed that the trident had missed the vascular structures of neck and the spine. Surgical removal of the metallic trident was planned after proper informed consent. Patient was intubated in lateral decubitus and the metallic trident was successfully removed from the neck in retrograde manner along the path of entry after incising along the entry wound to dislodge the foreign body from the submuscular plane.

Discussion :

Relevant literature was reviewed to understand appropriate management strategies. Neck injury by penetrating metallic foreign body should be done in a systematic manner comprising of clinical, radiological and anesthetic assessment. Vascular injury to be assessed at the earliest. Intubation in the lateral decubitus is a very effective method of securing the airway and induction and maintenance of anesthesia under such situations.

Conclusion :

Exclusion of neurovascular injury in penetrating neck trauma is of utmost importance in selection of imaging modality for the specific case. Multi-disciplinary team approach is desirable in selected cases with an experienced anesthesia team well versed in lateral decubitus intubation, videolaryngoscopy and flexible fibreoptic bronchoscopic intubation.