A Manual of the Operations of Surgery: For the Use of Senior Students, House Surgeons, and Junior PractitionersBell, Joseph
Science
A Manual of the Operations of Surgery: For the Use of Senior Students, House Surgeons, and Junior Practitioners
Bell, Joseph
Surgery, Operative
1. LIGATURE OF EXTERNAL CAROTID.--Head in same position as for the
common carotid. A straight incision parallel with the anterior edge of
sterno-mastoid, but about half an inch in front of it, must begin almost
at angle of jaw, and extend downwards nearly to the level of the thyroid
cartilage. Cautiously divide skin, platysma, and fascia; the lower end
of the parotid must be pulled upwards, and the veins, which are
numerous, cautiously separated. The anterior border of the
sterno-mastoid must be pulled backwards, and the digastric and
stylo-hyoid forwards and inwards. The superior laryngeal nerve which
lies behind the vessel must be avoided.
2. LIGATURE OF LINGUAL.--To secure this vessel either before it becomes
concealed by the hyo-glossus, or after it is under the muscle, a curved
incision is necessary, following the line of the hyoid bone, and
especially of its greater cornu, but a line or two above its upper
border. After the skin and platysma are divided, the posterior belly of
the digastric must be recognised, which again will guide to the
posterior edge of the hyo-glossus. The edge of the sub-maxillary gland
may very probably require to be raised out of the way. The artery can
then be secured, either before it dips under the hyo-glossus muscle, or
after it has done so, by the division of a few of its fibres on a
director. Care is needed to avoid injury of the hypo-glossal nerve,
which lies above the muscle.
The internal carotid artery occasionally, but very rarely, is the
subject of aneurism. It may, like any other artery, be wounded,
especially from the fauces. The treatment of either of these lesions is
ligature of the common carotid itself, in preference to ligature of the
internal carotid. Guthrie's operation for securing the bleeding internal
carotid at the injured spot, by dividing and turning up the ramus of the
lower jaw, has never been performed in the living body, and is so
difficult, dangerous, and unnecessary, as not to merit description.
LIGATURE OF SUBCLAVIAN.--_Note._--In consequence of the difference in
the origin, and variety in the anatomical relations of the right and
left subclavian arteries, in so far at least as their first stage is
concerned, it is necessary to give a very brief separate account of
each.
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