Critical airway in crisis: A trauma surgeon's dilemma

Penetrating neck trauma presents a complex surgical emergency due to the presence of vital airway, vascular, and neural structures in a confined space. Securing the airway is the first and most critical step. This case series describes three patients with penetrating neck injuries at or above the level of thyroid cartilage, managed using individualized airway strategies. One patient required surgical tracheostomy distal to injury with repair of the thyrohyoid membrane, one underwent awake fiberoptic intubation followed by repair, and one was managed with computed tomography angiography (CTA) of the neck and local exploration with primary repair. All patients were successfully weaned from airway support, demonstrated normal phonation and swallowing, and were discharged uneventfully. This series highlights the importance of early airway assessment and an individualized approach.