Neck trauma can be a major emergency. The neck is the passageway for all of the nerves that are contained within the spinal cord. It’s the path of communication between your brain and every organ in your body. Understanding the neck zones can help you recognize symptoms of trauma as they pertain to this sensitive region.

Neck Trauma Basics And History

The types of neck injuries that can result in blunt force or penetrating trauma include whiplash, clotheslining, shrapnel wounds, falls, gunshot wounds and stabbing. Most of these are not very common.

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If you do end up with neck trauma, managing it can be especially tricky. Assessing the damage is complex because there are so many structures in the area. It is also important to pay attention to the neurological, vascular, digestive and respiratory impact of neck trauma.

A patient’s life can hang in the balance when a neck injury is involved. Many times, individuals who have been injured appear stable at first. Identifying injury early on can improve their chances of surviving with optimal health.

A neck injury can damage the bones as well as the surrounding soft tissue. Each vertebra is connected with muscles, ligaments and discs. The discs along the spine cushion shock and absorb impact.

Nerves travel through the neck carrying vital messages between the brain and the body. Many arteries and blood vessels are also located in the area. Damage to these can affect just about any organ or function in the rest of the body.

The severity of an injury depends on the area of the spinal cord that is affected. However, immediate treatment can help improve mortality rates.

Before World War II, penetrating neck injuries were treated by watching and waiting. Mortality rates at that time were as high as 35 percent. To prevent unnecessary deaths, a mandatory surgical approach was implemented among practitioners. This improved outcomes, but it wasn’t always necessary to perform surgery on patients.

Beginning in the 1990s, trauma surgeons began to favor selective management. Although some practitioners believe that the patient’s stability is the driving force behind making treatment decisions, many choose to plan their strategy based on the zones of the neck.

Neck Trauma Zones

To properly assess a neck injury, medical professionals categorize trauma as blunt force or penetrating injury, such as a gunshot. They also divide the area into three zones. Understanding each zone is vital for assessing possible damage and managing neck trauma in patients.

Medscape contains an illustration that identifies the different neck zones.

Zone I

Zone I comprises the base of the neck. Controlling the blood vessels in this area after a stab or gunshot wound can be challenging. This zone is the most difficult to assess and manage.

Patients who are in shock or bleeding profusely should be examined in the operating room. An angiography, looking at the blood vessels with an X-ray, can help doctors plan their surgical approach.

When you’re dealing with an injury to this zone, the risk of mortality is high. The sternum can get in the way of accessing the area underneath. A sternotomy or thoracotomy may be necessary to control bleeding.

Zone II

Zone II is the middle section of the neck. This zone is the most exposed. Therefore, it is the most susceptible to injury.

Injuries in this zone have the best prognosis. Medical professionals have better access to this region than to zones I and III. Therefore, a surgical exploration of the blood vessels in this region is usually preferable to an angiography.

Zone III

Zone III is the uppermost zone. It starts at the angle of the jawline and ends between the mouth and nose. Hemorrhaging in this area is often caused by damage to the branches of the external carotid artery. Sometimes, cutting through the jawbone is necessary to gain access to this zone.

How Is Neck Trauma Assessed?

If you have experienced a blunt or penetrating trauma to the neck, doctors will evaluate you systematically. They’ll look at the presenting signs and symptoms as they relate to the different neck zones.

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First, the clinician will evaluate the airway. A laryngoscopy or imaging can help medical professionals get a clear view and watch for post-injury changes.  CT imaging can help doctors plan a surgical route for dealing with a laryngeal injury.

Second, the doctor will check for signs of hematoma or injury to the blood vessels. He or she may listen for the sounds of the blood pumping. Anomalies can indicate damage. Hemorrhage and loss of pulse also necessitate surgical exploration.

Risk factors will also be taken into account. If the patient has sustained a head injury, shows signs of swelling or has damaged the skull or jaw, diagnostic imaging may be conducted. Vertebral fractures can also be examined in this way.

Cervical spine injury can be evaluated with X-rays. Doctors will compare symptoms of neurological and musculoskeletal complaints with their findings.

Is Surgery Necessary?

According to emDocs, medical professionals should evaluate stable victims of neck injury based on hard and soft signs. Hard signs indicate the need for emergency measures. Soft signs give you more time and require reevaluation and close observation.

Soft signs include:

  • Vomiting blood
  • Bleeding from the mouth
  • Labored breathing
  • Difficulty swallowing
  • Trouble talking because of vocal cord issues
  • Air outside of the lungs
  • Chest tube air leak
  • Stable hematoma
  • Central nervous system deficits affecting a specific part of the body

Hard signs include:

  • Expanding hematoma
  • Bleeding that doesn’t stop
  • Shock doesn’t respond to fluids
  • Slowed or absent pulse in the wrist
  • Abnormality in the way the blood flow sounds through a stethoscope
  • Limited blood flow to the brain
  • Airway blockage


Dealing with neck trauma can be complicated because the injury may not manifest evident symptoms or signs. Potentially fatal damage can be easily overlooked without a clear way of exploring the situation. Waiting too long to discover an injury can put a patient’s life in danger. Using the zones can help medical professionals understand the severity of the situation and evaluate the location for treatment. 

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