You evaluate an 18 yrs old male who sustained a right sided cervical laceration during a gang fight. Which of the following is a relative rather than an absolute indication for neck exploration?

Pneumothorax Repos of a more than 50% incidence of negative explorations of the neck, iatrogenic complications, and serious injuries overlooked at operation have caused a reassessment of the dictum that all penetrating neck wounds that violate the platysmaQ must be explored. Stable patients with zone II (between the angle of the mandible and the skull) or zone I (inferior to the cricoid cailage) injuries, or multiple neck wounds, should undergo initial angiographyQ irrespective of the ultimate treatment plan. Algorithms exist for nonoperative management of asymptomatic patients that employ observation alone or combinations of vascular and aerodigestive contrast studies and endoscopy. Neveheless, recognition of acute signs of airway distress (stridor, hoarse ness, dysphonia), visceral injury (subcutaneous air, hemoptysis, dysphagia), hemorrhage (expanding hematoma, unchecked external bleeding), or neurologic symptoms referable to carotid injury (stroke or altered mental status) or lower cranial nerve or brachial plexus injury requires formal neck exploration. Pneumothorax would mandate a chest tube; the necessity for exploration would depend on clinical judgment and institutional policy.