Surgical anatomy for students / by A. Marmaduke Sheild.

  • Sheild, A. Marmaduke (Arthur Marmaduke)
Date:
1891
Catalogue details

Licence: Public Domain Mark

Credit: Surgical anatomy for students / by A. Marmaduke Sheild. Source: Wellcome Collection.

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    eight are found in the neck. They are incomplete hehind, where the tuhe is somewliat flattened, and its calibre therefore is not quite round. In the child, and in adults with short, fat necks, not more than one and a half to two inches of the trachea lie in the neck, even Avhen the head is well throwii back. In such subjects, too, the tube recedes towards the episternal notch, and may lie a full inch and a half from the surface at the root of the neck. The relations of the trachea in the neck are as follows:—In front is the integument and fascia, the isthmus of the thyroid gland, and a plexus of thyroid veins. The prfe-tracheal fascia is very dense and tough, being derived from the cervical fascia. The anterior jugular veins are often connected with a large branch just above the sternum ; and, in children, the left innominate vein, with large inferior thyroid veins running into it, crosses the trachea just at the episternal notch, shewing in the neck. This is a perilous anatomical relation for low tracheotomy in young children. On either side are the sterno-thyroids and sterno-hyoids, the lobes of the thyroid gland, and the carotid sheath, with the thyroid arteries and recurrent nerves. Behind is tlie oesophagus and the recurrent laryngeal nerves. In the thorax the trachea is crossed by the left innominate vein, the arch of the aorta, the left common carotid, and has anterior to it also the remains of the thymus gland. Behind it is the oesophagus. On either side of the trachea lie thfe pleural sacs. The innominate artery and vagus nerve are on its right side, the carotid on its left. High tracheotomy is a safer operation than low tracheo- tomy, on account of the depth of the trachea at the root of the neck, and the large veins which cross it. The essential points in tracheotomy are as follows:—Keep strictly in tlie middle line. Draw aside with forceps or blunt hooks any large veins which may be in the way. Draw forcibly down- wards the isthmus of the thyroid gland. Never open the trachea till you can clearly see two or more rings. Then pass the knife in below, and cut deliberately upwards in
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