Neck trauma: Clinical

The neck is a compact tube packed with many vital structures including blood vessels like the carotid artery and internal jugular vein, nerves like the brachial plexus, parts of the airway like the larynx and trachea, and parts of the digestive tract, such as the pharynx and esophagus. As a result, even seemingly innocuous traumatic injury can be lethal. The cervical spine is the most flexible and mobile part of the vertebral column.

But, that flexibility comes with a price, making the cervical spine the most vulnerable part of the vertebral column to trauma. Now, neck trauma can be classified into penetrating neck injury, like that from a knife stab, and blunt neck injury, like that from a car crash.

Before delving into penetrating neck injuries, it’s crucial to review the anatomy. The neck is anatomically divided into three zones. From bottom to top, zone I, or the lower zone, is from the clavicles to the cricoid cartilage, zone II, or the middle zone, is from the cricoid cartilage to the angle of the mandible, and zone III, or the upper zone, is from the angle of the mandible to the base of the skull. To help you remember the order of the zones, think of going up an elevator, so zones I, II, III from bottom to top. The neck is enveloped by the superficial and deep cervical fascia, and sandwiched between them is the platysma muscle.

Anatomically, the neck can also be described in triangles. The sternocleidomastoid muscle separates the neck into two triangles. The anterior triangle contains most of the major anatomic structures, including the larynx, trachea, pharynx, esophagus and major vascular structures; while the posterior triangle contains muscles, the spinal accessory nerve, and the spinal column.