Military Injuries to the Head and Neck—Implications for Practice in Resource Constrained Environments

• Published in: Operative techniques in otolaryngology--head and neck surgery 2020-12, Vol.31 (4), p.339-352
• Main Authors: Tonn, Christopher R., Ward, Matthew L., Abadie, Wesley M., Lally, John W., Bevans, Scott E., Henry, LaKeisha R.
• Format: Article
• Language: English
• Subjects: Blunt neck trauma; Combat facial trauma; Laryngeal fracture; Laryngotracheal injury; Penetrating neck injuries; Resource constrained environment
• ISSN: 1043-1810; 1557-9395
• DOI: 10.1016/j.otot.2020.10.012

Our objective was to use a series of cases from the wars in Iraq and Afghanistan to highlight challenges in treating in head and neck trauma in a resource constrained environment either in a deployed military or humanitarian settings. When outside of a well-resourced hospital system, otolaryngologists must maintain a broad and comprehensive skill set in order to provide an equivalent standard of care. Whether practicing in a deployed military or humanitarian capacity, these resource-constrained environments require that surgeons consider the differences in their patient population, injury patterns, environmental risks, and communication limitations. Surgical techniques may need to be altered by available instrumentation, limited operating room time, increased risk of infection and difficulties in continuity of care. In many cases, these legitimate concerns can be mitigated by leveraging treatment guidelines and nearly ubiquitous access to expert subspecialty advice that global communication now allows. Herein, through a case-based discussion, several practical considerations of treating head and neck trauma in an austere environment are discussed. Whether in a war zone, providing humanitarian care in foreign countries, or even within our native borders during a national emergency, otolaryngologists may be able to anticipate and overcome important challenges to continue providing standard of care surgery.