MyMedR

Fulltext Cricotracheal separation: a case of delayed diagnosis and treatment

Hashima AR, Marina MB, Sani A

Med J Malaysia, 2011 Jun;66(2):144-5.

A motorcyclist was involved in a motor vehicle accident and presented with respiratory distress and neck swelling with surgical emphysema. He sustained gross tracheal injury, severe pneumothoraces and lung contusions. As intubation was successful, the tracheal injury was not addressed immediately in view of the other severe respiratory problems. Evidence of aspiration lead to further investigations which confirmed the diagnosis 22 days post trauma. Thyrotracheal anastomosis was carried out without stenting. A complete cricotracheal separation is a rare event and can be easily overlooked in the emergency department.

Matched MeSH terms: Neck Injuries/diagnosis*; Neck Injuries/etiology; Neck Injuries/therapy*

Fulltext Valsalva manoeuvre to detect isolated hyoid bone fracture

Mohd Hamdan MH, Saniasiaya J, Narayanan P

BMJ Case Rep, 2021 Jul 13;14(7).

PMID: 34257127 DOI: 10.1136/bcr-2021-243756

The hyoid bone fracture has traditionally been attributed to strangulation and hanging. Although rare, ensuing its vague presentation, hyoid bone fracture is oftentimes overlooked and missed, leading to delayed complications. Herein, we are reporting an overlooked hyoid bone fracture in a man who attempted suicide by strangulating himself, whereby Valsalva manoeuvre performed during bedside flexible nasopharyngolaryngoscopy revealed the fractured segment. As the patient was stable and asymptomatic, he was successfully managed conservatively. We would like to highlight the awareness of the Valsalva manoeuvre, which could elicit hyoid bone fracture as missing or overlooking the fracture may lead to devastating complications which may ensue, such as respiratory distress.

Matched MeSH terms: Neck Injuries*

Hanging without knot in the noose

Kumar V

J Forensic Leg Med, 2007 Jan;14(1):35-8.

PMID: 16530454

Death by hanging is believed to be a painless method of committing suicide. In most cases the noose has a knot and on this basis only it can be labeled as atypical or typical hanging. A 35 year Chinese man committed suicide by hanging with a ligature material made of electric wire where there was no knot present on the noose.

Matched MeSH terms: Neck Injuries/etiology*; Neck Injuries/pathology

Isolated hyoid bone fracture in a child due to a fall

Chainchel Singh MK, Siew SF, Lai PS

Int J Pediatr Otorhinolaryngol, 2020 Dec;139:110443.

PMID: 33068949 DOI: 10.1016/j.ijporl.2020.110443

Hyoid bone fractures due to blunt trauma are rare accounting for only 0.002% of all head and neck fractures with most documented fractures being due to strangulation, hanging, motorcycle helmet straps, sports injuries and rarely as a complication of intubation. However, they are even rarer in the paediatric age group. We present a hyoid bone fracture in a two-year-old child as a result of a fall down three steps. Hyoid bone fractures though generally heal well with conservative treatment must be diagnosed early to avoid air way obstruction leading to morbidity and mortality.

Matched MeSH terms: Neck Injuries*

Extrusion of fish bone through the neck

An HK

Med J Malaya, 1972 Mar;26(3):215-6.

PMID: 5064004

Matched MeSH terms: Neck Injuries*

Fulltext Transverse sacral fracture-dislocation with anterior displacement: a case report

Tiew S, Tay T

Malays Orthop J, 2012 Nov;6(3):63-5.

PMID: 25279063 MyJurnal DOI: 10.5704/MOJ.1207.010

Transverse sacral fracture is a very rare injury and frequently missed or delayed in diagnosis. We present a case with this injury and discuss its management.

Matched MeSH terms: Neck Injuries

Thyroid rupture secondary to blunt neck trauma

Sow YL, Aziz NA, Ng KL

Am J Emerg Med, 2013 Apr;31(4):760.e3-5.

PMID: 23399341 DOI: 10.1016/j.ajem.2012.12.005

Rupture of the thyroid gland is uncommon in cases of blunt neck trauma. We report a case of thyroid rupture after a motor vehicle accident in a patient without a preexisting goiter. He presented with a painful anterior neck swelling associated with dysphagia and hoarseness of voice. Computed tomographic scans showed lacerations of the right thyroid lobe and isthmus with features suggestive of slow active bleeding. Neck exploration was subsequently performed, and a ruptured right thyroid lobe was found with ongoing venous hemorrhage. A right hemithyroidectomy was performed, and the patient recovered without complications.

Matched MeSH terms: Neck Injuries/complications*; Neck Injuries/radiography; Neck Injuries/surgery

Fulltext Rigid endoscope guided removal of penetrated embedded neck foreign body

Paul M, Kalimuthu S, Banu C, Marimuthu S

Trauma Case Rep, 2018 Dec;18:5-7.

PMID: 30505922 DOI: 10.1016/j.tcr.2018.11.002

Penetrative neck injury can cause potentially fatal damage to the neck. Removing those fully embedded small foreign bodies secondary to ballistic trauma can be technically challenging. Neck exploration under direct vision may cause more local tissue damage or dislodge the foreign body further. We discussed a case where a small foreign body embedded in the neck caused by ballistic trauma. Successful removal of the foreign body guided by rigid endoscope thru the neck wound was also discussed as a useful tool as it was not ferromagnetic and image intensifier was not available.

Matched MeSH terms: Neck Injuries

Fulltext Foreign body aspiration in adult: removing aspirated foreign body using flexible bronchoscopy in emergency department

Ismail, M.S., Fareena, Z.

Medicine & Health, 2020;15(1):294-299.

MyJurnal

Aspirasi bendasing boleh mengancam nyawa. Presentasi yang tidak tipikal dan kekurangan pengimejan diagnostik, telah membuatkan kecurigaan klinikal adalah penting. Kami ingin melaporkan kes aspirasi bendasing dalam seorang dewasa yang hadir ke Jabatan Kecemasan dalam keadaan yang tidak sedarkan diri. Lelaki berusia 31 tahun yang lumpuh disebabkan oleh keretakkan ‘cervical 7th fracture’ dihantar ke Jabatan Kecemasan selepas tidak sedarkan diri dan mengalami penurunan peratusan oksigen disebabkan oleh aspirasi bendasing. Ini adalah kes atipikal aspirasi bendasing pada pesakit yang berjaya didiagnosis dan dirawat menggunakan bronkoskopi fleksibel di Jabatan Kecemasan. Aspirasi bendasing pada orang dewasa sering diabaikan terutama jika ia tidak menyebabkan sesak nafas. Indeks kecurigaan yang tinggi diperlukan terutamanya untuk pesakit berisiko tinggi yang menunjukkan simptom atipikal. Bronkoskopi fleksibel dan ‘rigid’ adalah kaedah diagnosis dan rawatan pesakit yang disyaki aspirasi bendasing. Kesimpulannya, pelbagai jenis penemuan klinikal aspirasi bendasing yang tidak aspirasi dalam saluran udara pada orang dewasa telah dipaparkan. Faktor diagnostik yang paling penting adalah indeks klinikal curiga yang tinggi. Walaupun bronkoskopi ‘rigid’ terus menjadi instrumen pilihan untuk menghilangkan bendasing yang tidak aspisasi di saluran udara orang dewasa, tetapi bronkoskop optik gentian optik juga boleh digunakan dalam keadaan yang tertentu.

Matched MeSH terms: Neck Injuries

Fulltext Rare and Unique Case of Midline Anterior Arch of Atlas Non-formation Mimicking Jefferson Type 1 Fracture

Das S, Palaniandy K, Abu Bakar A, Idris Z, Abdullah JM

Cureus, 2020 Feb 03;12(2):e6850.

PMID: 32181085 DOI: 10.7759/cureus.6850

Cervical spine injuries are rare occurrences in children, especially the congenital anomalies of the atlas vertebra. Any injury involving the craniovertebral junction such as Jefferson fracture, is a valid cause for alarm due to the complex nature of the craniovertebral junction and the morbidity associated with it. We report the case of a 10-year-old male, who had failure of fusion of anterior arch of atlas due to the failure of formation of the anterior midline synchondrosis, and this mimicked a Jefferson fracture. If it was not for the peculiar absence of any corresponding evidence to suggest spinal injury, we might have mistaken this extremely rare but benign anomaly for a Jefferson fracture and subjected the patient to needless surgical treatment. Hence, it is concluded that keen clinical acumen and clear understanding of the developmental anatomy of these patients may be necessary to adequately manage them.

Matched MeSH terms: Neck Injuries

Condom-murder

Murty OP

J Forensic Leg Med, 2009 Jan;16(1):35-9.

PMID: 19061848 DOI: 10.1016/j.jflm.2008.05.017

Condom-murder is term used to describe a homicide where a person has been killed due to his recreational sexual behaviour and the killing has strong links with the recovered condom/contraceptive material on the scene or was in personal possession of victim. It can provide immediate clue about perpetrator. We present six cases of a similar nature. Four males and two females had condoms in their vicinity at crime scene. All incidents occurred at different timings and different places but there was striking similarity in method of killing. In four cases hands were tied on the back in three cases; similarly legs were also tied in three cases. In three cases strong electric cords were used. The presence of condoms give clue for investigation, possibility of DNA identification, about type of sexual behaviour as recreational and commercial method in these cases.

Matched MeSH terms: Neck Injuries/pathology

Delayed hanging death: a case report

Kumar V

J Pak Med Assoc, 2007 Jan;57(1):39-41.

PMID: 17319420

Matched MeSH terms: Neck Injuries*

Relationship between cervical spine injury and helmet use in motorcycle road crashes

Ooi SS, Wong SV, Yeap JS, Umar R

Asia Pac J Public Health, 2011 Jul;23(4):608-19.

PMID: 21768134 DOI: 10.1177/1010539511413750

Motorcycle helmets have been proven to prevent head injury and reduce fatality in road crashes. However, certain studies indicate that the helmet increases the mass to the head, and thus the potential of neck injury due to the flexion/extension of the head-neck segment in a road crash may increase. This study was conducted to evaluate the effects of motorcycle helmets and the ways in which the accidents that occurred affected the incidence of cervical spine injury. Nevertheless, it is not intended to and does not discredit the fact that helmet use prevents many motorcyclists from sustaining serious and fatal head injuries. A total of 76 cases were collected and analyzed based on the data collected from real-world crashes. The Abbreviated Injury Scale (AIS) was used to assess the severity of injury, whereas the statistical Pearson χ(2) correlation method was used for analysis. The results showed that motorcycle helmets did not affect the severity of cervical spine injury. However, when the samples were further subcategorized into different crash modes, it was found that helmets affect the incidence of a severe cervical spine injury. In frontal collisions, the use of helmets significantly reduces the severity of cervical spine injury, whereas in rear-end, side impact, and skidded accidents, the use of helmets increases the probability of a severe cervical spine injury. However, in the latter crash modes, a motorcyclist without a helmet will have to trade-off with head injury. A logistic regression model has been developed with respective crash modes and the probabilities of risk in having severe cervical spine injury have been calculated. Future designs in motorcycle helmets should therefore consider the significance of nonfrontal accidents and the interaction of helmet with other parts of the body by possibly considering the weight of the helmet.

Matched MeSH terms: Neck Injuries/etiology; Neck Injuries/physiopathology

Fulltext Novel role of focused airway ultrasound in early airway assessment of suspected laryngeal trauma

Adi O, Sum KM, Ahmad AH, Wahab MA, Neri L, Panebianco N

Ultrasound J, 2020 Aug 12;12(1):37.

PMID: 32783133 DOI: 10.1186/s13089-020-00186-3

BACKGROUND: Upper airway injury secondary to blunt neck trauma can lead to upper airway obstruction and potentially cause a life-threatening condition. The most important aspect in the care of laryngeal trauma is to establish a secure airway. Focused airway ultrasound enables recognition of important upper airway structures, offers early opportunity to identify life-threatening upper airway injury, and allows assessment of the extent of injury. This information that can be obtained rapidly at the bedside has the potential to facilitate rapid intervention.

CASE PRESENTATION: We report a case series that illustrate the diagnostic value of focused airway ultrasound in the diagnosis of laryngeal trauma in patients presenting with blunt neck injury.

CONCLUSION: Early recognition, appropriate triaging, accurate airway evaluation, and prompt management of such injuries are essential. In this case series, we introduce the potential role of focused airway ultrasound in suspected laryngeal trauma, and the correlation of these exam findings with that of computed tomography (CT) scanning, based on the Schaefer classification of laryngeal injury.

Matched MeSH terms: Neck Injuries

Retained haemodialysis-catheter guidewire in the head and neck: a multidisciplinary team approach

Xiao Hong C, Abd Wahab S, Azman M

BMJ Case Rep, 2020 Oct 27;13(10).

PMID: 33109696 DOI: 10.1136/bcr-2020-236484

Penetrating foreign body in the head and neck can be catastrophic from injury to the constellation of vascular and neural structures in the neck. Early recognition and prompt surgical intervention is imperative to save lives. Herein, we present an unusual case of iatrogenic foreign body-a coiled guidewire embedded in the deep neck space. The complications, radiological investigation and multidisciplinary surgical management are further discussed.

Matched MeSH terms: Neck Injuries/diagnosis*; Neck Injuries/etiology; Neck Injuries/surgery

Fulltext Massive subcutaneous emphysema after a blunt neck injury

Mohamad, I., Md Shukri, N., Fauzi, M.H., Abdul Karim, A.H., Nik Hassan, N.F.H.

Malaysian Journal of Emergency Medicine, 2017;2(1):16-20.

MyJurnal

Subcutaneous emphysema can occur after a breach to the air-containing space. The classical condition will be ruptured alveolus in chronic lung disease. A disruption of the upper airway such as trauma to the laryngotracheal framework may lead to similar presentation. The amount of air leak varies depending on site and size of the breach. We report a case of blunt neck trauma after a fall from bicycle, which ended with massive subcutaneous emphysema, pneumothorax and pneumomediastinum requiring intubation.

Matched MeSH terms: Neck Injuries

Fulltext Isolated blunt lingual artery injury secondary to a road traffic accident: diagnostic and therapeutic approach

Mawaddah A, Goh BS, Kew TY, Rozman Z

Malays J Med Sci, 2012 Apr;19(2):77-81.

PMID: 22973141 MyJurnal

Neurologic and airway compromise as a result of traumatic vascular injuries to the neck region often lead to more severe complications and thus require special consideration. Furthermore, these cases pose diagnostic and therapeutic challenges to healthcare providers. Here, we report a case of a 28-year-old motorcyclist presenting with progressively enlarged Zone 2 neck swelling on the left side following a high impact collision. There were no symptoms or signs suggesting neurologic or laryngeal injury. Computed tomography angiogram of the neck revealed signs of an active arterial bleed. The apparent vascular injury was managed by close observation for signs of airway compromise, urgent angiogram, and selective catheter embolisation of the left lingual artery. The patient subsequently recovered without further operative exploration of the neck. At 6 months post-trauma, the neck swelling fully subsided with no complications from angioembolisation. This case illustrates the individualised treatment and multidisciplinary approach in managing such cases. We review our rationale for this diagnostic and therapeutic approach.

Matched MeSH terms: Neck Injuries

Potential forensic implications of kerokan therapy - a traditional Indonesian therapy associated with neck bruising

Samberkar PN, Samberkar SP, Byard RW

Med Sci Law, 2020 Oct;60(4):315-318.

PMID: 32501165 DOI: 10.1177/0025802420926867

Kerokan is a traditional Indonesian treatment involving abrading the skin over various parts of the body with a blunt object such as a coin or a piece of ginger which may create suspicious injuries. Here, the case of a 30-year-old woman who had undergone kerokan therapy is reported. She was complaining of retro-sternal pain and epigastric discomfort and subsequently became markedly short of breath and died. The observation of injuries predominantly located around the neck initiated a police investigation and forensic autopsy. Scattered abrasions, blisters and bruises were present on the forehead, the bridge of the nose extending to the ala, the upper and anterior aspect of the chin and the sternal notch, with discrete fresh and scabbed abrasions around the neck, over the sternum and on the backs of both hands. There were, however, no facial or conjunctival petechiae and no bruising of the underlying strap muscles, or fractures of the hyoid bone or thyroid cartilage. Histology revealed that myocarditis was the cause of death. Traditional practices may cause unusual bruises, abrasions, blisters and burns that may raise suspicion of inflicted injury from an assault. Knowledge of the manifestations of socio-ethnic practices such as kerokan is important in the evaluation of trauma in specific cultural groups.

Matched MeSH terms: Neck Injuries/pathology*

Fulltext A study of computer-related upper limb discomfort and computer vision syndrome

Sen A, Richardson S

J Hum Ergol (Tokyo), 2007 Dec;36(2):45-50.

PMID: 18572794 DOI: 10.11183/jhe1972.36.2_45

Personal computers are one of the commonest office tools in Malaysia today. Their usage, even for three hours per day, leads to a health risk of developing Occupational Overuse Syndrome (OOS), Computer Vision Syndrome (CVS), low back pain, tension headaches and psychosocial stress. The study was conducted to investigate how a multiethnic society in Malaysia is coping with these problems that are increasing at a phenomenal rate in the west. This study investigated computer usage, awareness of ergonomic modifications of computer furniture and peripherals, symptoms of CVS and risk of developing OOS. A cross-sectional questionnaire study of 136 computer users was conducted on a sample population of university students and office staff. A 'Modified Rapid Upper Limb Assessment (RULA) for office work' technique was used for evaluation of OOS. The prevalence of CVS was surveyed incorporating a 10-point scoring system for each of its various symptoms. It was found that many were using standard keyboard and mouse without any ergonomic modifications. Around 50% of those with some low back pain did not have an adjustable backrest. Many users had higher RULA scores of the wrist and neck suggesting increased risk of developing OOS, which needed further intervention. Many (64%) were using refractive corrections and still had high scores of CVS commonly including eye fatigue, headache and burning sensation. The increase of CVS scores (suggesting more subjective symptoms) correlated with increase in computer usage spells. It was concluded that further onsite studies are needed, to follow up this survey to decrease the risks of developing CVS and OOS amongst young computer users.

Matched MeSH terms: Neck Injuries/epidemiology

Fulltext A rare case of traumatic bilateral sixth cranial nerve palsy

Hamidon, B.B., Md Shariful, H.S., Nasaruddin, M.Z.

International Medical Journal Malaysia, 2012;11(2):50-52.

MyJurnal

Traumatic bilateral sixth cranial nerve palsy is a rare condition which is typically associated with additional intracranial, skull, and cervical spine injuries. We describe a case of complete bilateral sixth nerve palsy in a 28-year-old female patient after an alleged motor vehicle accident. She had altered level of consciousness but no intracranial lesion or associated skull or cervical spine fracture was detected. In this case, we discussed the differential diagnoses, initial workup, and possible treatment options in cases of traumatic 6th nerve palsy.

Matched MeSH terms: Neck Injuries

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