Cervical cutthroat injury with complete hypopharyngeal transection: a case report

Penetrating neck trauma involving the aerodigestive tract is a life-threatening emergency. We report a case of an 18-year-old male patient with a zone II cervical wound that caused complete hypopharyngeal transection and a thyroid cartilage fracture. Initial airway control was achieved by direct translaryngeal intubation through the wound, followed by bilateral chest tube placement for pneumothoraces that developed after positive pressure ventilation. Surgical management included tracheostomy, primary hypopharyngeal and laryngeal reconstruction, and vascular control. The postoperative course was complicated by aspiration pneumonia, a strap muscle abscess requiring drainage, opioid withdrawal, and neuroleptic malignant syndrome. Despite these complications, the patient survived and was discharged after approximately 1 month with a gastrostomy tube because of persistent severe dysphagia. This case illustrates the need for flexible airway management, definitive surgical repair, and close postoperative surveillance for complex systemic complications in severe penetrating neck trauma.