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Objectives: Fireworks are used commonly for celebrations in the United States, but can lead to severe injury to the head and neck. We aim to assess the incidence, types, and mechanisms of head and neck injuries associated with fireworks use from 2010 to 2019., Methods: A retrospective cross-sectional study, using data from the National Electronic Injury Surveillance System, of individuals presenting to United States Emergency Departments with head and neck injuries caused by fireworks and flares from 2010 to 2019. Incidence, types, and mechanisms of injury related to fireworks use in the US population were assessed., Results: A total of 541 patients (349 [64.5%] male, and 294 [54%] under 18 years of age) presented to emergency departments with fireworks-related head and neck injuries; the estimated national total was 20 584 patients (13 279 male, 9170 white, and 11 186 under 18 years of age). The most common injury diagnoses were burns (44.7% of injuries), laceration/avulsion/penetrating trauma (21.1%), and otologic injury (15.2%), which included hearing loss, otalgia, tinnitus, unspecified acoustic trauma, and tympanic membrane perforation. The remaining 19% of injuries were a mix, including contusion, abrasion, hematoma, fracture, and closed head injury. Associations between fireworks type and injury diagnosis (chi-square P  < .001), as well as fireworks type by age group (chi-square P  < .001) were found. Similarly, associations were found between age groups and injury diagnoses (chi-square P  < .001); these included children 5 years and younger and adults older than 30 years., Conclusions: Fireworks-related head and neck injuries are more likely to occur in young, white, and male individuals. Burns are the most common injury, while otologic injury is a significant contributor. Annual rates of fireworks-related head and neck injuries have not changed or improved significantly in the United States in the past decade, suggesting efforts to identify and prevent these injuries are insufficient.

Study Design: Descriptive epidemiology study., Objective: The purpose of this study was to describe the epidemiology of cervical spine injuries in collegiate football players., Summary of Background Data: The incidence and etiology of cervical spine injuries in National Collegiate Athletic Association (NCAA) football players has not been well defined in recent years., Methods: The incidence and characteristics of cervical spine injuries were identified utilizing the NCAA-ISP database. Rates of injury were calculated as the number of injuries divided by the total number of athlete-exposures (AEs). AEs were defined as any student participation in one NCAA-sanctioned practice or competition., Results: An estimated 7496 cervical spine injuries were identified. Of these, 85.6% were categorized as new injuries. These occurred at a rate of 2.91 per 10000 AEs. Stingers were most common (1.87 per 10000 AEs) followed by cervical strains (0.80 per 10000 AEs). Injuries were nine times more likely to occur during competition when compared with practice settings. When compared with the regular season, the relative risks of sustaining a cervical spine injury during the preseason and postseason were 0.69 (95% CI 0.52-0.90) and 0.39 (95% CI 0.16-0.94), respectively. The rate of cervical spine injuries was highest in Division I athletes. Direct contact-related injuries were most common, representing 90.8% of all injuries sustained. Injuries were most common in linebackers (20.3%) followed secondarily by defensive linemen (18.2%). Most players returned to play within 24 hours of the initial injury (64.4%), while only 2.8% remained out of play for > 21 days., Conclusion: Fortunately, the rate of significant and disabling cervical spine injuries appears to be low in the NCAA football athlete. The promotion of safer tackling techniques, appropriate modification of protective gear, and preventive rehabilitation in these aforementioned settings is of continued value., Level of Evidence: 4.

Background: Penetrating neck trauma is uncommon in children; consequently, data describing epidemiology, injury pattern, and management are sparse. The aim of this study was to use the National Trauma Data Bank (NTDB) to describe pediatric penetrating neck trauma (PPNT)., Methods: The NTDB was queried for children (defined as <15 years old) with PPNT between years 2008 and 2012. Descriptive analysis was used to describe age groups (0-5, 6-10, and 11-14 years) and injury type categorized as aerodigestive, vascular, cervical spine, and nerve., Results: A total of 1,238 patients with penetrating neck trauma were identified among 434,788 children in the NTDB (0.28%). Mean age was 7.9 years, and 70.6% of patients were male. The most common mechanisms of injury were stabbing (44%) and gunshot/firearm (24%). Most patients were treated at a pediatric trauma center (65.8%). Computed tomographic scan was the most frequent (42.2%) diagnostic study performed, followed by laryngoscopy (27.0%) and esophagoscopy (27.4%). Almost a quarter of patients (23.7%) went directly to the operating room from the emergency department (ED). Aerodigestive injuries were most common and occurred more frequently in the youngest age group (p < 0.001). Operative procedures for aerodigestive type injuries were most common (82.7%). There were 69 deaths, yielding a mortality rate of 5.6%. When adjusting for age, admission to a pediatric trauma center, and injury type, only vascular injury (odds ratio, 3.92; 95% confidence interval, 2.19-7.24; p < 0.0001) and ED hypotension (odds ratio, 27.12; 95% confidence interval, 15.11-48.67; p < 0.0001) were found to be independently associated with death., Conclusion: PPNT is extremely rare--0.28% reported NTDB incidence. Age seems to influence injury type but does not affect mortality. Computed tomographic scan is the dominant diagnostic study used for selective management. Vascular injury type and hypotension on presentation to the ED were independently associated with mortality., Level of Evidence: Prognostic/epidemiologic study, level III.

Background: Optimal airway management following repair of cervical tracheal injuries is unknown. This study aimed to determine the optimal airway strategy following cervical tracheal injury repair., Methods: Patients with cervical tracheal injuries admitted from January 2000 to January 2014 at seven US Level I trauma centers were identified. Patients were grouped depending on postoperative airway management: immediate or early extubation (≤24 hours, EXT), prolonged intubation (>24 hours, INT), and immediate tracheostomy (TRACH). Following univariate analysis, a multivariate model was then developed to evaluate for surgical site infection (SSI) and intensive care unit-free and ventilator-free days, comparing INT and TRACH with EXT as the reference., Results: A total of 120 cervical tracheal injuries were treated at seven Level I trauma centers. Ten patients were excluded for incomplete data, and seven died within 24 hours of admission, leaving 103 patients included in the study. Patients were grouped based on airway management: 40 (39%) in the EXT, 30 (29%) in the INT, and 33 (32%) in the TRACH group. There were no differences in demographics or injury mechanism. The INT and TRACH groups were more severely injured than the EXT group (median Injury Severity Score [ISS]: INT, 25; TRACH, 17 vs. EXT, 16; p < 0.01). Despite a higher SSI rate (TRACH, 21% vs. INT, 13% vs. EXT, 2%; p = 0.11), the TRACH group had a lower mortality rate (TRACH, 0% vs. INT, 13% vs. EXT, 0%, p < 0.01) and more ventilator-free days compared with the INT cohort. On multivariate analysis, tracheostomy was associated with an increased risk in the odds of SSI (odds ratio, 9.56; 95% confidence interval, 1.35-67.95) compared with both EXT and INT, while INT was associated with fewer ventilator-free days (correlation coefficient, -9.24; 95% confidence interval, -12.30 to -6.18) compared with both EXT and TRACH., Conclusion: In patients with a cervical tracheal injury, immediate or early extubation was common and safe. However, among those with more severe injuries, immediate tracheostomy versus prolonged intubation presents a risk-benefit decision. Immediate tracheostomy is associated with increased risk of SSI, while prolonged intubation is associated with higher risk of mortality and fewer ventilator-free days., Level of Evidence: Therapeutic study, level IV.

Background: Neck trauma in the pediatric population is relatively rare with limited discussion in the literature describing the injury patterns and outcomes of all neck trauma victims. This study characterizes pediatric neck trauma both inside and outside the context of injuries requiring otolaryngology (ENT) intervention., Methods: Patients sustaining neck trauma presenting to a single tertiary care hospital between January 2001 and June 2010 were included. Demographic information was obtained in addition to information regarding the initial hospital stay and follow up visits related to the initial trauma., Results: Seventy-four patients were included. Blunt injuries were found in 44 children with 30 sustaining penetrating injuries. Twenty-eight percent of patients had an ENT consultation. Those patients with injuries warranting ENT consultation were nearly 3 times more likely to require intubation than those without an ENT consultation (p=0.009). Laryngotracheal injuries were documented in 11 patients with 6 of these characterized as major injuries and 5 minor injuries., Conclusion: Pediatric neck trauma represents a spectrum of injuries from ecchymosis to major laryngotracheal injury. Otolaryngology involvement is not necessary in all cases; however, one must be aware of the risk of laryngotracheal injury, particularly with blunt trauma and there should be a low threshold for Otolaryngology consultation and endoscopy., (Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.)

Dental professionals can play an important role in identifying and referring victims of domestic violence. Since most of the injuries sustained by victims occur in the head and neck region, dentists are uniquely positioned to help address this enormous public health issue. Unfortunately, dentists are the least likely of all health professionals to identify and refer victims of abuse. Much of this failure may be attributed to a lack of knowledge. This article provides an overview of the types and indicators of abuse, information about screening and interviewing victims, and referral resources.

Objectives: To examine the surgical outcomes of penetrating neck trauma patients in Operation Iraqi Freedom (OIF) and compare treatment and perioperative survival to historical data with low-velocity penetrating neck trauma seen in a noncombat clinical setting., Study Design: Case series with chart review., Setting: Air Force Theater Hospital at Balad Air Base, Iraq., Subjects and Methods: The surgical management of penetrating neck trauma by 6 otolaryngologists deployed over a 30-month period at the United States Air Force Theater Hospital in Balad, Iraq, was retrospectively reviewed. The presenting signs and symptoms, operative findings, and outcomes of patients who underwent neck exploration for high-velocity penetrating neck trauma were determined. A treatment algorithm defining the management of both high-velocity and low-velocity penetrating neck trauma is recommended., Results: One hundred and twelve neck explorations for penetrating neck trauma were performed in OIF over 30 months. Ninety-eight percent of these neck injuries were due to high-velocity projectiles. In patients, zone 1 injuries occurred in 10%, zone 2 injuries in 77%, zone 3 injuries in 5%, combined zone 1/2 injuries in 5%, and combined zone 2/3 injuries in 3%. The positive exploration rate (patients with intraoperative findings necessitating surgical repair) was 69% (77/112). The mortality of patients undergoing neck exploration for high-velocity penetrating neck trauma was 3.7%., Conclusions: The perioperative mortality and the positive exploration rate for high-velocity penetrating neck trauma by deployed surgeons in OIF are very comparable to those rates seen in civilian centers managing low-velocity penetrating neck trauma.

Since most domestic violence injuries occur in the head and neck areas, it is critical that dental professionals be prepared to identify, interview, and assist potential victims. The purposes of these surveys in 1996 and 2007 were to investigate U.S. and Canadian dental school curricula regarding the inclusion of domestic violence topics, determine the topics emphasized, determine beliefs of course directors about domestic violence issues, and report progress of dental curricula in preparing dental professionals regarding domestic violence over the eleven-year period. Surveys were sent to associate deans for academic affairs of dental schools in the United States and Canada in 1996 (N=64) and the United States in 2007 (N=56). Each academic dean was asked to forward the survey to the faculty member who taught this topic. Topics most frequently included and emphasized in dental school curricula were the responsibility of the health care professional (HCP) regarding domestic violence, how to identify physical and behavioral indicators, and how to refer the abused victim. The topics least frequently included and emphasized in the curricula regarded education of the abused and the impact of domestic violence on society. There were four strong beliefs reported by dental course directors: a trusting, professional rapport is essential for disclosure; the dentist or a dental team member may be the first HCP to recognize signs of abuse; the dentist has a professional responsibility to refer for assistance; and domestic violence education should be included in dental curricula. Over the eleven years, the surveys demonstrate that course directors have become more aware of the need to inform dental students about domestic violence and that more schools have increased the amount of information about domestic violence in dental courses. However, due to the complexity and sensitivity of this topic, course instructors in dental schools may consider other teaching methods to enhance learning. The authors identified the need for further course development and make recommendations to use experiential learning to enhance dental students' interpersonal and interviewing skills. These strategies may increase dentists' comfort and confidence when treating and assisting possible victims of domestic violence.

Catastrophic neck injury is defined as a structural distortion of the cervical spinal column associated with actual (or potential) damage to the spinal cord. Although uncommon, this type of traumatic injury can lead to severe neurologic sequelae in the collision sport athlete. Emergency care is complicated by the helmet and shoulder pads worn by the athlete. A thorough understanding of the clinical anatomy, diagnostic considerations, and protocols for on-site evaluation and management is necessary to optimize outcome.

Objective: At the time of this study, the 1st place that an injured or ill American soldier in Iraq or Afghanistan would have been evaluated by an ENT-head and neck surgeon was at a tertiary care medical center as a result of air evacuation out of theater: Landstuhl Regional Medical Center (LRMC), Ramstein, Germany. By examining the ENT-related diagnoses of all air evacuations from downrange, we were able to match the patients classified as having battle injuries to determine the percentage with head and neck trauma., Study Design: A prospective review of 11,287 soldiers air-evacuated from Afghanistan and Iraq, representing the 1st year of combat operations. A new, computerized patient-tracking system was created by our team to merge several disparate databases to generate and compile our data., Results: The ENT-head and neck surgery department evaluated and primarily managed 8.7% of all patients evacuated out of theater by air to Germany. Other medical and surgical services managed 7.3% of all patients evacuated out of theater with overlapping ENT diagnoses. The number of potential ENT patients increased to 16% when one looked at all head and neck pathology instances seen by all medical and surgical departments hospitalwide. Of all patients air-evacuated and classified as having battle injuries, 21% presented with at least 1 head and neck trauma code., Conclusions: This is the 1st paper focusing on the role of the ENT-head and neck surgeon in treating a combat population and also the patterns of illness and head and neck injuries in a deployed force in our modern military. Improved soldier body armor has resulted in distinctly new patterns of combat injuries. Unprotected areas of the body account for the majority of injuries., Significance: These findings should be used to improve the planning and delivery of combat medical care.

Head and cervical spine sports-related injuries are intimately associated. The on-field evaluation and management of the athlete with these injuries is of paramount importance to stabilize the athlete and prevent further injury. Clinicians need to be aware of the differential diagnoses and consider each possibility based on the mechanism of injury. Although recognition of head and cervical spine injuries has resulted in significant reductions of catastrophic neurological injuries, especially in the cervical spine, further advances to decrease the incidence and long-term sequelae of head and neck injuries are needed. The first step is education of the athlete and the individuals involved in the care of that athlete.

This article reviews the on the field management of athletic cervical spine and spinal cord injury. The various types of injuries are discussed, as well as the team approach to evaluation, immobilization, and transport of the injured athlete. An overview of treatment rationale and decisions regarding the return of the spine-injured or spinal cord-injured player to competition is given. Emphasis is placed on the prevention of further injury by mishandling the injured athlete.

Neck injuries in sports are common, typically debilitating, and quite predictable in retrospect by mechanism of injury as to one of four natures--sprains/strains, fractures, brachial plexus pinches/stretches, and spinal cord injury. Of these, the spinal cord injury, whether a concussion or contusion or physical disruption, is obviously the most severe and also, ironically, the best tracked because of its definition and notoriety when it is experienced. This article discusses the essence of what has been learned epidemiologically over recent decades since the advent of organized attention to spinal cord injuries among athletes.