0:01

As we leave the topic of facial and neck trauma,

0:05

it's important for me to mention a few other entities

0:08

that can occur lower down in the neck rather

0:10

than the facial bones. Here's one of them.

0:13

Here's a patient who has an air leak that occurred

0:17

due to traumatic injury to the larynx.

0:21

So the patient shows widening of the thyroid

0:25

thyroid cartilage from side to side with an air

0:28

collection which is communicating with the

0:30

paraglottic space. And then from the paraglottic space,

0:34

it goes out into the anterior strap muscles.

0:37

So this is an airway injury.

0:40

And whenever you see unexplained

0:42

emphysema in the neck,

0:43

you want to make sure that there isn't a communication

0:46

with either the breathing tube or the swallowing tube,

0:51

as the case may be.

0:53

Here you can see that in point of fact,

0:55

that small air leak at the thyroid notch led

1:00

to gross air in the subcutaneous tissue,

1:03

outlining the carotid artery in the jugular vein and

1:06

separating the visceral space

1:09

from the carotid space.

1:10

So communication even into the epidural space of the

1:15

spinal canal, airway injury. And this may occur usually,

1:20

with regard to the larynx, rarely with the trachea.

1:24

The second neck injury that I'd like to

1:27

mention is the carotid dissection.

1:32

Patients with carotid dissection will

1:35

present with neck pain. Rarely,

1:38

but most importantly they may present with a stroke

1:41

and that is because of a thrombus which forms

1:45

along the dissected internal carotid artery.

1:48

The third common presentation besides neck

1:52

pain and stroke is the presence of a Horner

1:56

syndrome because of involvement of the

1:58

sympathetic nervous system plexus which

2:02

abides within the carotid sheath.

2:05

Here we have the normal right internal carotid

2:08

artery with fat around the blood vessels

2:11

into the parapharyngeal space.

2:13

Here we have a narrowed internal carotid

2:16

artery and if we do fat suppression,

2:18

we'd see that this is bright signal intensity that's not

2:21

due to fat but is due to hemorrhage in the wall

2:24

accounting for the narrowing of the internal

2:26

carotid artery with carotid artery dissection.

2:29

This up here is the parapharyngeal space.

2:32

This is the post-styloid parapharyngeal space or the

2:35

carotid sheath structures with a carotid dissection.

2:39

When you look at carotid dissection,

2:41

you just should be aware of the so called Biffl

2:44

scale for carotid dissection. Grade one,

2:46

irregularity or dissection with less than 25% stenosis.

2:50

Grade two, greater than 25% luminal narrowing.

2:53

Grade three, pseudo aneurysm. Grade four,

2:56

complete occlusion of the dissected carotid artery.

3:00

And grade five, transection with active contrast extravasation

3:04

extravasation. A word on carotid dissection and

3:09

the seatbelt sign. So the seatbelt sign,

3:11

as I mentioned previously,

3:12

is the discoloration across the shoulder and neck

3:16

secondary to the trauma of the seatbelt

3:18

as you are forced forward or back,

3:20

depending upon on which side the car is hit.

3:24

The seatbelt sign, in and of itself, is not a

3:27

good predictor of carotid dissection.

3:29

In fact,

3:30

we looked at a multi institutional

3:32

study with over 500 cases,

3:35

and carotid dissection from the seatbelt sign

3:38

alone occurred in only three out of 500 cases.

3:42

So, very uncommon.