الفهرس 
Anatomy of the neckOnly 14 pages are availabe for public view
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Abstract
Trauma is a major health and social problem and is the main cause of death in people up to the age of 38 years, fewer than 10 % of patients with poly trauma have associated vascular injuries, but these injuries can cause significant morbidity and mortality.
The incidence and type of vascular trauma differs between various societies. in most Europeans countries today the majorities of vascular trauma is caused by blunt (traffic accidents) and iatrogenic injuries.
In south Africa and USA, injuries are mostly penetrating and have also changed from predominantly stab wounds to injuries caused by firearms.
Neck injuries are notoriously difficult to evaluate and treat because of the complex anatomy and the dense concentration of numerous vital structures in a small anatomical area. The clinical evaluation can challenge the skills of the less experienced physician and significant injuries may easily be missed. The radiological evaluation of these injuries has undergone major changes in the last few years and shifted from invasive diagnostic procedures to noninvasive methods. The selection of the most appropriate investigation remains a controversial issue.
The surgical exposure of some neck blood vessels such as the distal carotid artery, the subclavian vessels, and the vertebral artery can challenge the surgical skills of even the most experienced trauma or vascular surgeons and requires excellent knowledge of the local anatomy. The management of some of these injuries, such as carotid injury in the presence of neurological deficits or blunt carotid trauma, still remains controversial. The advancement of interventional radiology has revolutionized many aspects of the management of some complex vascular injuries that are difficult to manage operatively.
Emergent surgical exploration is indicated for any immediate life threatening signs or symptoms from penetrating neck trauma (i.e., massive bleeding, expanding hematoma, nonexpanding hematoma in the presence of haemodynamic instability, haemomediastinum, haemothorax, hypovolemic shock).
For the stable patient, the choice of treatment remains controversial.
Knowledge of the neck zone involvement (I, II, or III), mechanism of injury, and velocity of the projectile are helpful in determining the likelihood of vital structure injury. Presently, many trauma centers manage stable patients with non life-threatening penetrating neck trauma with selective exploration; however, this must be supported by on-site angiography, flexible and rigid endoscopy, and closely monitored physical examinations. Zone I and zone III injuries usually require arteriography on all stable patents. also Stable patients with zone II injuries may require angiography.
Because hemorrhage is the leading cause of death for penetrating neck injuries, hemodynamic and neurologic status should always be monitored closely for at least 48 to 72 hours.
In blunt neck trauma, injuries can involve the laryngeal, cervical, vascular, and digestive structures. Symptoms can present in a delayed fashion and be easily missed. For these reasons, careful observation should be made for individuals with significant blunt neck trauma in order to monitor for progressive signs and symptoms of laryngeal, cervical, vascular, and digestive injury.