Self-inflicted powered knife penetrating neck injury - A case report
DOI:
https://doi.org/10.34631/sporl.927Keywords:
neck injury, suicide, reconstructive surgeryAbstract
Laryngeal fractures are a rare event. Penetrating neck injuries produced by powered tools can be life-threatening and pose a challenge for head and neck surgeons. We report the case of a 51-year-old male that attempted suicide by self-inflicting a penetrating anterior neck injury with a powered knife. Neck exploration revealed section of all infrahyoid muscles exposing the carotid artery bilaterally, multiple laryngeal fractures, hypopharyngeal and esophageal lacerations. We classified the penetrating injury as a Schaefer-Fuhrman group 4. Reconstruction of the hypopharynx, esophagus and strap muscles was done with absorbable sutures. Reconstruction of the thyroid cartilage was performed with non-absorbable sutures. Post-operative evaluation revealed structural integrity of the hypopharynx and esophagus, as well as bilateral vocal fold mobility 6 months after the surgery. To improve patient survival and outcome, it’s of utmost importance that head and neck surgeons have a comprehensive understanding of the management of these unusual type of injuries.
References
Jalisi S, Zoccoli M. Management of Laryngeal Fractures - A 10-Year Experience. J Voice. 2011 Jul;25(4):473-9. doi: 10.1016/j.jvoice.2009.12.008.
Schaefer SD. The Acute Management of External Laryngeal Trauma: A 27-Year Experience. Arch Otolaryngol Head Neck Surg. 1992 Jun;118(6):598-604. doi: 10.1001/archotol.1992.01880060046013.
Koehler SA, Luckasevic TM, Rozin L, Shakir A, Ladham S, Omalu B, et al. Death by chainsaw: fatal kickback injuries to the neck. J Forensic Sci. 2004 Mar;49(2):345-50.
Ribeiro-Costa N, Carneiro Sousa P, Abreu Pereira D, Azevedo P, Duarte D. Laryngeal Fracture after Blunt Cervical Trauma in Motorcycle Accident and Its Management. Case Rep Otolaryngol. 2017;2017:9321975. doi: 10.1155/2017/9321975.
Kim JP, Cho SJ, Son HY, Park JJ, Woo SH. Analysis of clinical feature and management of laryngeal fracture: Recent 22 case review. Yonsei Med J. 2012 Sep;53(5):992-8. doi: 10.3349/ymj.2012.53.5.992
Thevasagayam MS, Pracy P. Laryngeal trauma: A systematic approach to management. Trauma. 2005;7(2):87–94. doi: 10.1191/1460408605ta336oa
Zribi M, Ben Amar W, Bardaa S, Hammami Z, Maatoug S. Unusual suicide by electric saw: A case report. Egypt J Forensic Sci. 2015;5(3):126–8. doi:10.1016/j.ejfs.2014.08.002
Krauss P, Butenschoen VM, Meyer B, Negwer C. Sub-decapitation in suicidal chainsaw injury: report of a rare case and operative management. Acta Neurochir (Wien). 2020 Oct;162(10):2537-2540. doi: 10.1007/s00701-020-04413-7.
Hammig B, Jones C. Epidemiology of Chain Saw Related Injuries, United States: 2009 through 2013. Adv Emerg Med. 2015;2015:1–4. doi:10.1155/2015/459697.
Fuhrman GM, Stieg FH 3rd, Buerk CA. Blunt laryngeal trauma: classification and management protocol. J Trauma. 1990 Jan;30(1):87–92.
Minard G, Kudsk KA, Croce MA, Butts JA, Cicala RS, Fabian TC. Laryngotracheal trauma. Am Surg. 1992 Mar;58(3):181–7.
Grewal H, Rao PM, Mukerji S, Ivatury RR. Management of Penetrating Laryngotracheal Injuries. Head Neck. Nov-Dec 1995;17(6):494-502. doi: 10.1002/hed.2880170607.
Granholm T, Farmer DL. The surgical airway. Respir Care Clin N Am. 2001 Mar;7(1):13-23. doi: 10.1016/s1078-5337(05)70020-4.
Tisherman SA, Bokhari F, Collier B, Cumming J, Ebert J, Holevar M. et al. Clinical practice guideline: penetrating zone II neck trauma. J Trauma. 2008 May;64(5):1392-405. doi: 10.1097/TA.0b013e3181692116.
Teixeira F, Menegozzo CAM, Netto SD do C, Poggeti RS, Collet e Silva F de S, Birolini D. et al. Safety in selective surgical exploration in penetrating neck trauma. World J Emerg Surg. 2016 Jul 12;11:32. doi: 10.1186/s13017-016-0091-4
Nowicki JL, Stew B, Ooi E. Penetrating neck injuries: A guide to evaluation and managementx. Ann R Coll Surg Engl. 2018 Jan;100(1):6-11. doi: 10.1308/rcsann.2017.0191.
Burgess CA, Dale OT, Almeyda R, Corbridge RJ. An evidence based review of the assessment and management of penetrating neck trauma. Clin Otolaryngol. 2012 Feb;37(1):44-52. doi: 10.1111/j.1749-4486.2011.02422.x.
Madiba TE, Muckart DJJ. Penetrating injuries to the cervical oesophagus: Is routine exploration mandatory? Ann R Coll Surg Engl. 2003 May;85(3):162-6. doi: 10.1308/003588403321661307.
Lupetin A, Hollander M, Rao V. CT Evaluation of Laryngotracheal Trauma. Semin Musculoskelet Radiol. 1998;2(1):105-116. doi: 10.1055/s-2008-1080090.
Butler AP, O’Rourke AK, Wood BP, Porubsky ES. Acute external laryngeal trauma: Experience with 112 patients. Ann Otol Rhinol Laryngol. 2005 May;114(5):361-8. doi: 10.1177/000348940511400505.
Hirano M, Kurita S, Terasawa R. Difficulty in High-Pitched Phonation by Laryngeal Trauma. Arch Otolaryngol. 1985 Jan;111(1):59-61. doi: 10.1001/archotol.1985.00800030093015.
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