Surgical anatomy / by John A.C. Macewen.

  • Macewen, John A. C.
Date:
1910
Catalogue details

Licence: In copyright

Credit: Surgical anatomy / by John A.C. Macewen. Source: Wellcome Collection.

Provider: This material has been provided by The University of Glasgow Library. The original may be consulted at The University of Glasgow Library.

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    and inwards, and numerous lymphatic glands lie in this posi- tion, while posterior to the sheath the cervical sympathetic runs. Other posterior relations are the inferior thyroid and vertebra] arteries, prevertebral fascia and muscles, the trans- verse processes of the cervical vertebrae, and, on the right side, the recurrent laryngeal nerve. On the left side the nerve is internal. Anteriorly, the sheath is crossed by the omo- hyoid muscle and a branch of the superior thyroid artery, at the level of the sixth cervical. The artery is generally ligatured above this point, as it is more superficial, being overlapped by the sterno-mastoid, while below this point it is covered by the sterno-hyoid, thyroid, and mastoid muscles, the lateral lobe of the thyroid, and thyroid veins. This point, therefore, is an important one surgically, and is defined deeply by the tubercle on the transverse process of the sixth cervical {Chassaignac's tubercle), which forms a reliable guide to the artery in ligaturing, and against which the artery may be compressed. The common carotid is sometimes affected by aneurism, which occurs generally at the bifurcation, where there is normally a dilatation, or at the root of the neck. The pressure exerted on the surrounding structures by the tumour may give rise to spasm of the larynx, and of the diaphragm, contracted pupil (sympathetic), oedema, and lividity of face and arm, and anaemia of the brain. Ligature of the common carotid may be performed for aneurism affecting the vessel itself, for aneurism of the innominate (Wardrop's operation), for wounds of the vessel, and profuse haemorrhage from the neck or throat (sarcoma, etc.). Where possible the artery should be ligatured above the omo-hyoid (seat of election). The line of the artery is from the sterno-clavicular articulation to a point midway between the angle of the jaw and the mastoid process, and a 3-inch incision is made along this line, with its centre opposite the cricoid. The deep fascia is divided, the sterno-mastoid drawn back, the omo-hyoid drawn down, the sheath cleared, opened on its inner side, and the needle passed from without inwards to avoid the vein, the vagus also being avoided. The subsequent anastomosis is between the superior and inferior thyroid vessels, branches of the two external carotids, a branch of the occipital of the carotid, and the superior intercostal of the subclavian ; but is frequently not sufificient, notwithstanding the circle of Wilhs, to keep
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