The airway in face, head and neck injury

Penetrating neck injury was first described 5 000 years ago on a piece of papyrus. Hugh Munro closed a longitudinal tracheal laceration in 1792 by using external straps. Horizontal lesions were sutured over a stent and the patient’s neck remained in the flexed position while the wound was allowed to heal. The first successful management of a penetrating vascular injury in the neck was achieved in 1952 (with no resultant stroke or hemiplegia), and the first bronchial laceration was repaired in 1945. Current mortality rates for penetrating neck injuries are quoted as ~2 to 6%. In the wars of the twentieth century, ending with the Vietnam War, the incidence was 7 to 15%. Mortality rates from the massive aspiration of blood, related cervicothoracic vascular injuries and other injured organs, can be as high as 15 to 30%. The highest mortality occurs with gunshot injuries (35%), followed by blunt trauma (25%) and stab wounds of the upper airway (22%).