# Pathological Mechanisms and Additional Factors Involved in Complex Neck Traumatology
## 1 Introduction  
Complex cervical traumas represent an otorhinolaryngological emergency with a constantly increasing incidence, representing 5-10% of cases that occur in emergency units, and are accompanied by significant mortality [1]. Traumatic injuries, which can occur, can be closed or open (penetrating/non-penetrating), and the determining mechanism varies from self-inflicted, aggression, or accidental. Socio-demographic factors, age, sex, pathological history, mental health, and access to health care are important epidemiological factors of the evolution and prognosis of trauma, but also on the results of statistical analysis [2]. The neck region contains the highest density of vital organs condensing inan anatomical area, which is not protected by a skeletal bone and makes it vulnerable to traumatic agents. The diversity of cervical anatomical elements determines the appearance of at least as many types of lesions [3; 4]. Today, the mortality rate for penetrating traumatic neck injuries is 3-6%, with 50% of deaths caused by hemorrhagic vascular injuries [5]. A complex pathology in continuous growth, with varied and severe evolution, the ENT surgeon must be prepared in terms of diagnosis and therapeutic approach regardless of the mechanism of production, lesion severity, or socio-demographic factors. There are several confounding factors that can influence the results and, more critically, the interpretation and conclusions of traumatological epidemiological analysis, which include: ethnicity, culture, socioeconomic status, access to health care, mental health, alcohol consumption, and other drugs. Due to their number and multitude, adequate control for any of the factors is difficult to achieve. Therefore, caution is advised in making generalizations about some epidemiological findings [6]. Injuries of the neck can be both open and closed, superficial and penetrating [7]. Penetrating cervical trauma is present in approximately 10% of all trauma patients [8; 9]. While open traumatic injuries to the neck are most commonly associated with acts of violence, they are also found in the road, sports, and occupational accidents. The penetration mechanism is important in determining the severity of the injury and the therapeutic behavior. Inevitably, vascular injury is the most common complication of penetrating neck injuries, which occur in about a quarter of all cases and have a mortality rate of almost 50% [10]. Laryngeal-tracheal injuries occur in a tenth of cases, and mortality in these cases is close to 20% [11; 12]. Internationally, the rate of penetrating neck injuries is usually closely linked to the rate of violence and the existence of military conflicts in a given country. Today, the mortality rate for penetrating traumatic neck injuries is 3-6%, with 50% of deaths caused by hemorrhagic vascular injuries. Traumatic neck injuries can be classified according to the existence of a solution of skin continuity in: closed and open and depending on the zonal character: zone I (clavicle--cricoid cartilage), zone II (cricoid cartilage--mandible angle), zone III (between mandible angle and skull base). Depending on the severity and the presence or absence of polytraumas and comorbidities, the previous cervical traumas are also classified into major/complicated and minor/simple [13]. Closed traumas are caused by direct blows with and blunt bodies and mechanical asphyxia (hanging, strangulation, and strangulation). Open injuries are caused by sharp objects and firearms [14; 15]. Closed injuries are most commonly caused by road accidents. The incidence of this type of injury is decreasing due to the obligation to wear seat belts, airbags, speed limits, and legislation regarding driving under the influence of alcohol. The mechanism of production consists of the anterior propulsion of the driver with the neck in hyperextension, during rapid deceleration.