Penetrating neck trauma may pose a diagnostic and therapeutic dilemma to emergency physicians and trauma surgeons. Approximately 5% to 10% of all trauma involves penetrating neck trauma,<sup>56 Thal E.R., Meyer D.M. Penetrating neck trauma Curr Probl Surg 1992 ;  29 : 10-55

Cliccare qui per andare alla sezione Riferimenti</sup> with multiple structures being injured in 30% of patients.<sup>13 Demetriades D., Skalkides J., Sofianos C. , e al. Carotid artery injuries: Experience with 124 cases J Trauma 1989 ;  29 : 91-94  [cross-ref]

Cliccare qui per andare alla sezione Riferimenti</sup> Thorough knowledge of the anatomy of the neck, physical assessment, and current recommendations for diagnostic and therapeutic interventions are necessary for appropriate management. Expeditious decision making often is required to prevent catastrophic airway, vascular, or neurologic sequelae.

Overall mortality because of penetrating neck trauma is as high as 11%.<sup>4 Asensio J.A., Valenziano C.P., Falcone R.E. , e al. Management of penetrating neck injuries: The controversy surrounding zone II injuries Surg Clin North Am 1991 ;  71 : 267-296

Cliccare qui per andare alla sezione Riferimenti</sup> Injury to certain anatomic structures (e.g., the carotid or subclavian vessels) may be fatal in two thirds of cases, however.<sup>13 Demetriades D., Skalkides J., Sofianos C. , e al. Carotid artery injuries: Experience with 124 cases J Trauma 1989 ;  29 : 91-94  [cross-ref]

Cliccare qui per andare alla sezione Riferimenti</sup> Compounding difficulties in evaluation and management is the complicated anatomy of the area, in which a dense concentration of vital vascular, aerodigestive, and nervous system structures are located within a very small space. In addition, there is a lack of consensus among trauma surgeons regarding injuries that mandate surgical exploration and those in which a conservative selective approach can be taken.

This article reviews the anatomy of the neck and provides guidelines for the initial assessment and management of penetrating neck trauma in the emergency department (ED). Methods for achieving airway control in difficult situations are presented, and controversies in the management of penetrating neck trauma are reviewed.