Blunt neck trauma is rare. The head, shoulders, and chest offer protection to the neck when it is in the neutral position. Hyperextension, hyperflexion, rotation, and direct blows contribute to blunt injuries. Most commonly, injury results from motor vehicle crashes, when the extended neck strikes the steering wheel or dashboard. 15 Shearing forces from shoulder safety belts are also responsible for injury. Motorcycles, snowmobiles, and all-terrain vehicles have been implicated in "clothesline" injuries. These occur when the exposed neck strikes a stationary cord. They are associated with severe laryngotracheal and esophageal injuries. Other mechanisms include direct blows sustained during sports (football, karate, hockey), handlebar injuries from bicycles, assaults, and strangulation. 16
Though uncommon, blunt cervical trauma can be lethal or can result in significant morbidity. Symptoms are often minimal, or delayed, and the diagnosis can be easily overlooked. Head, facial, and cervical spine injuries frequently accompany blunt neck trauma. Symptoms of vascular or aerodigestive injuries may be misinterpreted in the context of these associated injuries. A high index of suspicion must be maintained. Signs and symptoms or a significant injury mechanism mandate aggressive diagnostic evaluation, and admission for observation. As with penetrating trauma, surgical consultants should be involved in the initial assessment and management of all patients.
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