Securing the Airway in a Patient With a Penetrating Neck Injury: A Case Report

Penetrating neck injury presents significant challenges for anesthesiologists due to distorted anatomy, bleeding, and the risk of sudden deterioration. Airway management requires careful consideration of the technique selection to balance urgency with patient safety. We report a 30-year-old male with a self-inflicted knife injury to the anterior neck. Imaging revealed the blade traversing the sternohyoid muscle, grazing the thyroid, and extending toward the apical pleura, without vascular or airway breach. The patient was hemodynamically stable on arrival. After multidisciplinary planning, anesthesia was induced using a modified rapid sequence induction. Endotracheal intubation was successfully achieved on the first attempt with a video laryngoscope. A fiberoptic bronchoscope was introduced post-intubation to exclude airway injury. The knife was removed surgically without complications. Repeat bronchoscopy prior to extubation confirmed airway integrity. The perioperative course was uneventful, and the patient was discharged after one week with no sequelae. This case highlights the value of a combined approach using video laryngoscopy for primary airway control and post-intubation fiberoptic bronchoscopy for confirmation of tube placement and evaluation of internal injury. In penetrating neck trauma, such an integrated strategy enhances airway safety while minimizing additional harm. Nevertheless, preparedness for an immediate surgical airway remains essential, given the potential for rapid clinical deterioration.