FIGURE 112.5 A: Sensory dermatomes B: Motor dermatomes Knowledge of sensory and motor dermatomes can be invaluable in the description of neurologic findings during initial and subsequent evaluations FIGURE 112.6 Evaluation of blunt and penetrating neck trauma If there is evidence of crepitus over the larynx, laryngeal or tracheal tenderness, a flattened thyroid prominence, anterior neck deformity, severe respiratory distress, an abnormal neck radiograph, or other evidence suggestive of a laryngotracheal fracture or disruption, a tracheostomy may be preferable In this scenario, intubation should only be attempted if the airway is completely obstructed Attempts at intubation from above may separate a tenuously attached trachea and larynx, resulting in a total loss of the airway, with the trachea commonly retracting substernally into the chest ( Fig 112.7 ) Attempts at cricothyrotomy in patients with direct laryngeal trauma may result in retrotracheal placement of the airway Cricothyrotomy may be helpful in patients who have severe facial or other neck injuries that preclude intubation from above Intubation may be attempted through an open laryngeal wound if present, although, if possible, a tracheostomy should not be performed through injured tissue The flexible fiberoptic bronchoscope may be helpful in evaluating the patency of the airway and establishing the artificial airway If patient condition allows, rigid bronchoscopy can also be useful in securing an airway in these patients Care should be taken to ensure correct positioning and securing of the artificial airway, as the usual landmarks and adjacent tissues may be injured or altered Breathing abnormalities may suggest associated injuries Missiles to the neck may also pass through or lodge in the chest Zone I injuries of the neck can easily involve the lung apices and result in hemothorax, pneumothorax, or pneumomediastinum Further penetration may lead to cardiac tamponade A chest radiograph is helpful in the assessment A normal physical examination and chest radiograph are likely sufficient to obviate the need for arteriography in this population