Penetrating neck trauma with tracheal and oesophageal injuries

Failure to recognize early that penetrating neck wounds include the cervical oesophagus greatly increases morbidity and mortality. From an analysis of experience over 5 years (1978-1983) it emerges that, while tracheal wounds are usually recognized early, cervical oesophageal injuries are not. It is empyema which complicates such oesophageal injury and which prompts referral to a Department of Thoracic Surgery, the patients by this time being mortally ill, with septicaemia and malnutrition. Neck penetration is usually left-sided, the injuring agent usually a knife, driven downwards and medially by a right-handed assailant. Empyema is usually right-sided. Early recognition and prompt referral are associated with a low morbidity and low mortality. Late recognition and late referral carry a high morbidity rate, prolonged convalescence in those who survive, and a mortality rate of nearly 25 per cent.