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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    time of operation, and the condition of myxoederaa after.^ The essential points in the operation are—to make very free superficial incisions, so as exactly to localise important structures; to avoid wounding the capsule of the gland, in which lie the large veins; and to secure the structures at each angle by means of ligature before dividing them. Portions of the thyroid may be found in the neck, or even under the sternum, detached from the main gland. These are termed accessory thyroids, and are sometimes converted into enormous tumours. Tenotomy.—The sterno-mastoid is often divided just above its origin in cases of wry-neck. It is needful to avoid the external jugular vein at its posterior margin. The clavi- cular origin of the muscle overlies the internal jugular vein, the sternal, the carotid vessel. By keeping the muscle well on the stretch, entering a blunt-pointed tenotomy knife at a puncture made over the part to be divided, and turning its edge against the tendon close above the bone, all sub- jacent parts of importance should certainly be avoided. So far as safety is concerned, it is far better to divide this muscle through an open wound, whereby the parts above mentioned may be seen. The incision can afterwards be carefully sutured with horsehair. BraneMal Fistulas, and Comjenital Tumours.—The neck is sometimes the seat of minute fistulous openings, lined with epithelium, and several inches in length. These more com- monly occur above the clavicle, and communicate with the trachea or oesophagus. They are the remains of the branchial clefts of the foetus, which are four in number, the first corresponding to the Eustachian tube and formation of the tympanic cavity, the remaining three to the neck between the branchial arches. They should all be closed by the eighth week, in the embryo. Involutions of epidermis, and irregular obliteration of these clefts, have also been looked 1 Modern operators advise leaving a ]iortioii of the glaud to prevent tbis condition.
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