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1. Tympanic Membrane Repair................................................ 158
2. Ossicular Reconstruction...................................................... 158
3. Facial Nerve Repair................................................................. 159
VI. Prevention and Management of Complications
........................ 159
A. Indications for Antibiotics........................................................... 159
B. Hearing Loss...................................................................................160
C. Facial Nerve Injury........................................................................160
D. CSF Leaks......................................................................................... 161
E. Cholesteatoma and External Auditory Canal Injury.............. 161
F. Late Meningocele and/or Encephalocele Development..... 162
G. Late Meningitis.............................................................................. 162
VII. Summary
............................................................................................... 162
VIII. References and Suggested Readings
............................................ 163
Chapter 7: Penetrating and Blunt Neck Trauma
.....................................164
I.
Penetrating Neck Trauma
.................................................................164
A. Introduction....................................................................................164
B. Projectiles, Ballistics, and Mechanisms of Injury..................164
1. The Most Lethal Missiles...................................................... 165
2. Temporary and Permanent Bullet Cavities....................... 165
3. Historical Categorization, Types, and Treatment of
Penetrating Neck Wounds.................................................... 165
4. Historical Treatment of Penetrating Neck Wounds.......166
C. Emergency Room Management................................................166
1. Initial Orderly Assessment...................................................166
D. Anatomy.......................................................................................... 167
1. Vital Structures in the Neck.................................................. 167
2. Skeletal Anatomy.................................................................... 167
3. Muscular Landmarks.............................................................. 167
4. Neck Zones...............................................................................168
5. Vascular Injuries...................................................................... 170
E. Diagnostic Evaluation and Surgical Treatment...................... 170
1. Selective Neck Exploration................................................... 170
2. Mandatory Neck Exploration ............................................... 171
3. Computed Tomographic Angiography................................ 171
4. Evaluation of Aerodigestive Tract Injuries........................ 172
F. Conclusion...................................................................................... 173
II. Blunt Neck Trauma
............................................................................. 173
A. Introduction.................................................................................... 173
B. Presenting Signs and Symptoms............................................... 173
1. Initial Diagnostic Airway Evaluation. ................................. 173
2. Hemodynamic Instability or Signs of Vascular Injury...... 174