Penetrating Anterior Neck Injury with Through-and-Through Right Common Carotid Artery (CCA) Injury: A Case Report

Authors

  • Ploytip Jansiriyotin Department of Surgery, Khon Kaen Hospital https://orcid.org/0000-0002-1958-4072
  • Natawan Limrawikul Department of Surgery, Srinagarind Hospital, Faculty of Medicine, Khon Kaen University
  • Pagorn Limwattana Department of Surgery, Khon Kaen Hospital
  • Warit Werawatakul Department of Surgery, Khon Kaen Hospital

Keywords:

penetrating neck trauma, neck injury, vascular injury, carotid trauma

Abstract

Penetrating neck trauma is not uncommon
in Thailand. Whether accidental or intentional, the
management depends on presenting signs and
symptoms. Immediate control of hemorrhage and
airway protection of the airway compromise are
paramount, followed by timely decisions regarding
definitive surgical repair. Traditional management
using the three‑zone approach has increasingly
given way to the “no‑zone” strategy, guided by
modern diagnostic imaging. This report highlights
emergency decision‑making for airway and bleeding
control, zone‑based versus no‑zone evaluation
with computed tomography angiography (CTA),
operative findings of a through‑and‑through CCA
injury, and postoperative care and follow‑up.

References

Forner D, Noel CW, Guttman MP, Haas B, Enepekides D, Rigby MH, et al. Blunt Versus Penetrating Neck Trauma: A Retrospective Cohort Study. The Laryngoscope. 2021;131(4):E1109–16.

Monson DO, Saletta JD, Freeark RJ. Carotid vertebral trauma. J Trauma. 1969 Dec;9(12):987–99.

Ibraheem K, Khan M, Rhee P, Azim A, O’Keeffe T, Tang A, et al. “No zone” approach in penetrating neck trauma reduces unnecessary computed tomography angiography and negative explorations. J Surg Res. 2018 Jan 1;221:113–20.

Nowicki JL, Stew B, Ooi E. Penetrating neck injuries: a guide to evaluation and management. Ann R Coll Surg Engl. 2018 Jan;100(1):6–11.

Ibraheem K, Wong S, Smith A, Guidry C, McGrew P, McGinness C, et al. Computed tomography angiography in the “no-zone” approach era for penetrating neck trauma: A systematic review. J Trauma Acute Care Surg. 2020 Dec;89(6):1233–8.

Shiroff AM, Gale SC, Martin ND, Marchalik D, Petrov D, Ahmed HM, et al. Penetrating Neck Trauma: A Review of Management Strategies and Discussion of the ‘No Zone’ Approach. Am Surg. 2013 Jan 1;79(1):23–9.

Tessler RA, Nguyen H, Newton C, Betts J. Pediatric penetrating neck trauma: Hard signs of injury and selective neck exploration. J Trauma Acute Care Surg. 2017 June;82(6):989–94.

Reyna-Sepúlveda F, Cantu-Alejo D, Martinez-Fernandez A, Rodriguez-Garcia J, Guevara-Charles A, Perez-Rodriguez E, et al. 5-Year management and outcomes of penetrating neck injury in a trauma center. Penetrating neck injury. Cirugia Espanola. 2022 Oct;100(10):629–34.

Shiroff AM, Gale SC, Martin ND, Marchalik D, Petrov D, Ahmed HM, et al. Penetrating Neck Trauma: A Review of Management Strategies and Discussion of the ‘No Zone’ Approach. Am Surg. 2013 Jan 1;79(1):23–9.

Feliciano D, Mattox K, Moore E. Trauma, Ninth Edition. 9th edition. New York: McGraw-Hill Education / Medical; 2020. 1440 p.

Demetriades D, Inaba K, Velmahos G, editors. Atlas of Surgical Techniques in Trauma [Internet]. 2nd ed. Cambridge: Cambridge University Press; 2020 [cited 2021 Dec 4]. Available from: https://www.cambridge.org/core/books/atlas-of-surgical-techniques-in-trauma/F4D71F1067897354BE195DC1A9B3D19A

Asensio JA, Kessler JJ, Kotaru TR, Kalamchi LD, Miljkovic SS, Dabestani PJ. Penetrating Internal and Common Carotid Artery Injuries Shunts versus no shunts during repair effect on neurological outcomes. Injury. 2021 Feb 1;52(2):266–73.

Malek LA, Malek AK, Leszczynski J, Toutounchi S, Elwertowski M, Spiewak M, et al. Carotid Clamping Time as a Risk Factor for Early Restenosis After Carotid Endarterectomy. Eur J Vasc Endovasc Surg. 2005 Aug;30(2):143–6.

Chongruksut W, Vaniyapong T, Rerkasem K. Routine or selective carotid artery shunting for carotid endarterectomy (and different methods of monitoring in selective shunting). Cochrane Database Syst Rev. 2014 June 23;2014(6):CD000190.

Lin WC, Chen CW, Wang JD, Tsai LM. Is tracheostomy a better choice than translaryngeal intubation for critically ill patients requiring mechanical ventilation for more than 14 days? A comparison of short-term outcomes. BMC Anesthesiol. 2015 Dec 15;15:181.

Andriolo BN, Andriolo RB, Saconato H, Atallah ÁN, Valente O. Early versus late tracheostomy for critically ill patients - Andriolo, BNG - 2015 | Cochrane Library. [cited 2024 Oct 30]; Available from: https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD007271.pub3/full

Lui DH, Patel S, Khurram R, Joffe M, Constantinou J, Baker D. Mycotic internal carotid artery pseudoaneurysm secondary to Mycobacterium tuberculosis. J Vasc Surg Cases Innov Tech. 2022 June 1;8(2):251–5.

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Published

2025-12-31

How to Cite

1.
Jansiriyotin P, Limrawikul N, Limwattana P, Werawatakul W. Penetrating Anterior Neck Injury with Through-and-Through Right Common Carotid Artery (CCA) Injury: A Case Report. Thai J. Trauma [internet]. 2025 Dec. 31 [cited 2026 Jan. 2];44(2):47-53. available from: https://he05.tci-thaijo.org/index.php/TJT/article/view/6786

Issue

Vol. 44 No. 2 (2025): July - December 2025

Section

Case Report/Case Series

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