Abstract

Penetrating neck injury (PNI) in children is uncommon but potentially fatal because vascular, aerodigestive, and neural structures are concentrated within a confined anatomic space. We report a 7-year-old boy with hemodynamically unstable Zone II PNI after accidental impalement by a metallic rod. Because he presented with active external hemorrhage and hypotension, immediate surgical exploration was undertaken without preoperative computed tomographic angiography. Operative findings demonstrated complete transection of the right superior thyroid artery, a partial laceration of the right internal jugular vein, and a segmental right hypoglossal nerve injury. The superior thyroid artery was reconstructed with a short polytetrafluoroethylene (PTFE) interposition graft, the internal jugular vein was repaired primarily, and the hypoglossal nerve underwent epineural end-to-end repair under microscopy. Although the early postoperative course was initially satisfactory, progressive stridor and oxygen desaturation developed on postoperative day 3, and tracheostomy was required for airway protection. Serial Doppler ultrasonography confirmed vascular patency, and multidisciplinary rehabilitation enabled decannulation after 3 months. This case emphasizes that unstable pediatric Zone II PNI warrants immediate operative control of hemorrhage, that preservation-oriented vascular and neural repair can be feasible in selected patients, and that delayed airway compromise may occur when postoperative edema coexists with hypoglossal dysfunction.

Key words: Pediatric trauma, penetrating neck injury, zone II, superior thyroid artery, hypoglossal nerve