When permission is withheld for the removal of the neck-organs
they may be examined _in situ_, by freeing the skin of the neck
by a subcutaneous dissection, cutting the lobes and isthmus of
the thyroid in place and then opening the trachea and larynx by
an anterior median incision. The salivary glands, parathyroids,
cervical lymphnodes, vessels and nerves can all be examined by this
method without removing the organs as a whole.
In cases of aortic aneurism, corrosive poisoning, carcinoma of
œsophagus, trachea or bronchi, it is best to remove the neck-organs
in connection with the thoracic, removing first the neck-organs
down to the clavicles and then stripping all down to the diaphragm,
where they may be cut off and examined outside of the body. In
cases of poisoning it is often necessary to remove the œsophagus
in connection with the stomach. The mass of neck- and thoracic
organs are removed as far as the diaphragm and then allowed to lie
over the edge of the thorax or are turned down over the abdomen so
that the œsophagus is upward and the tongue toward the prosector.
The œsophagus and aorta are then separated from the other organs
and left in the thorax to be examined later in connection with the
abdominal organs.
If the thoracic duct was not examined when the thoracic organs
were, it may be examined after the section of the neck-organs is
finished, but it is more easily found after the method given above
by turning the right lung over into the left side of the thorax and
then looking for it in the neighborhood of the diaphragm, on the
right side behind the aorta and between it and the azygos vein.
It runs upward toward the left to the body of the last cervical
vertebra, then over the left subclavian artery downward to the left
innominate vein.
II. POINTS TO BE NOTED IN EXAMINATION OF THE MOUTH- AND NECK-ORGANS.
1. =Mouth.= Contents (blood, mucus, stomach-contents, foreign-bodies,
etc.), color of mucosa (normally grayish-red), vesicles (aphthæ),
cheilitis, gingivitis, various forms of stomatitis, noma,
scorbutus, Ludwig’s angina, ulcers (syphilis, carcinoma, decubital,
tuberculosis), hyperkeratosis, macrocheilia, thrush, scars, wounds,
action of corrosives, lead-line, neoplasms, etc. Note pillars of
fauces, size, shape and condition of uvula. If the teeth have not
been inspected during the general examination they should receive
attention at this time. Note malformations, anomalies, neoplasms
(adamantoma, odontoma, dental osteoma, various forms of cysts,
epulis, giant-cell sarcoma, papilloma, fibroma, etc.)
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