Clinical Practice and Cases in Emergency Medicine

Introduction: Penetrating neck injury is rare in children, but it can have devastating consequences due to the vital structures in the neck. Having a high index of suspicion is crucial for detection and management of such injuries. Superficial-appearing wounds can mask underlying injury. In this case report, we present a case of penetrating neck injury in a patient who presented with what appeared to be a simple laceration to his neck.

Case Report: A three-year-old male presented with a laceration to his neck caused by a piece of shattered glass. On evaluation, he had normal vital signs and no hard or soft signs of penetrating neck injury. During bedside examination, a track was found extending beyond the platysma. The patient developed hoarseness in his voice, prompting computed tomography (CT). The CT revealed three foreign bodies lodged between the right common carotid artery and tracheal wall, abutting the wall. The patient underwent open exploration with removal of the foreign bodies. No significant damage to vital structures was found.

Conclusion: While rare, this case exemplifies the importance of having a high index of suspicion for penetrating neck injury in children presenting with even superficial-appearing neck lacerations, especially if caused by glass. Because the neck is typically uncovered, it carries an increased risk for foreign body penetration. Glass is generally radiopaque, but detection may be limited by the surrounding tissue, fragment size, and glass composition. Patients demonstrating hard signs of penetrating neck injury require operative management, while those with soft signs should undergo assessment with CT.