Anatomy, Surgical and topographical -- Atlases; Surgery -- Atlases; Surgery, Operative -- Atlases
The middle point, between 7, the clavicle, and 6, the sternum, of Plate
4, is marked by a small triangular space occurring between the
clavicular and sternal divisions of the sterno-cleido-mastoid muscle.
This space marks the situation (very generally) of the bifurcation of
the innominate artery into the subclavian and common carotid arteries of
the right side; a penetrating instrument would, if passed into this
space at an inch depth, pierce first the root of the internal jugular
vein, and under it, but somewhat internal, the root of either of these
great arterial vessels, and would wound the right vagus nerve, as it
traverses this region. For some extent after the subclavian and carotid
vessels separate from their main common trunk, they lie concealed
beneath the sterno-mastoid muscle, B, Plate 4, and still deeper beneath
the sternal origins of the sterno-hyoid muscle, 5, and sterno-thyroid
muscle, some of whose fibres are traceable at the intervals. The
omo-hyoid muscle and the deep cervical fascia, as will be presently seen,
conceal these vessels also.
The subclavian artery, A, Plate 4, first appears superficial to the
above-named muscles of the cervical region just at the point where,
passing from behind the scalenus muscle, N, Plate 4, which also conceals
it, it sinks behind the clavicle. The exact locality of the artery in
this part of its course would be indicated by a finger's breadth
external to the clavicular attachment of the sterno-mastoid muscle. The
artery passes beneath the clavicle at the middle of this bone, a point
which is indicated in most subjects by that cellular interval occurring
between the clavicular origins of the deltoid and great pectoral
muscles.
The posterior cervical triangle, 9, 8, 7, Plate 4, in which the
subclavian artery is situated, is again subdivided by the muscle
omo-hyoid into two lesser regions, each of which assumes somewhat of a
triangular shape. The lower one of these embraces the vessel, A, and
those nerves of the brachial plexus, I, which are in contact with it.
The posterior belly of the omo-hyoid muscle, K, and the anterior
scalenus muscle, N, form the sides and apex of this lesser triangular
space, while the horizontal clavicle forms its base. This region of the
subclavian artery is well defined in the necks of most subjects,
especially when the muscles are put in action. In lean but muscular
bodies, it is possible to feel the projection of the anterior scalenus
muscle under the skin, external to the sterno-mastoid. The form of the
omo-hyoid is also to be distinguished in the like bodies. But in all
subjects may be readily recognised that hollow which occurs above the
clavicle, and between the trapezius, 8, and the sterno cleido-mastoid, 7
B, in the centre of which hollow the artery lies.
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