those below present with hemoptysis and persistent air leak, although any or all symptoms and signs listed in Table 112.3 may be present If a laryngeal injury is noted, the patient should be evaluated carefully for other commonly associated injuries, including in the cervical spine, chest, face, pharyngoesophageal area, and recurrent laryngeal nerve palsy Symptoms and signs of hyoid injury include pain in the throat that worsens with swallowing or coughing, tenderness to palpation, neck crepitus, pain on head rotation, dysphagia, dyspnea, or dysphonia The symptoms and signs associated with esophageal injury are listed in Table 112.3 and include neck tenderness and pain, dysphagia, odynophagia, drooling, crepitus, subcutaneous emphysema, hematemesis, fever, and mediastinitis (see Chapters 56 Pain: Dysphagia and 115 Thoracic Trauma ) The clinician must consider subclavian or innominate vessel injuries if a fracture of the clavicle or first rib is identified Patients with signs or symptoms of facial or neck burns will require careful assessment, as airway edema may initially be subtle but progress rapidly Early recognition and protection of a difficult airway are paramount Triage Considerations These patients require expedited evaluation, close monitoring and providers should anticipate difficult airway management Early transfer to a pediatric trauma center should be considered if appropriate surgical or critical care staff is not available Clinical Assessment As with all trauma patients, initial rapid assessment of their airway, breathing, and circulatory status should be completed Given the risk of airway injury, particular attention must be paid to subtle signs and symptoms of airway injury ( Table 112.3 ) Continued monitoring with repeat examinations is important in the recognition and identification of vascular and neurologic injuries ( Table 112.3 ) Refer to penetrating trauma clinical assessment section for detailed recommendations Management Blunt neck trauma requires similar vigilance and potentially similar diagnostic modalities as penetrating trauma Refer to penetrating trauma section for management recommendations Special management considerations are included there