Anatomy, Surgical and topographical -- Atlases; Surgery -- Atlases; Surgery, Operative -- Atlases
On the forepart of the tracheal median line, either superficial to, or
deeper than, the cervical fascia, the tracheotomist occasionally meets
with a chain of lymphatic glands or a plexus of veins, which latter,
when divided, will trammel the operation by the copious haemorrhage
which all veins at this region of the neck are prone to supply, owing to
their direct communication with the main venous trunks of the heart; and
not unfrequently the inferior thyroid artery overlies the trachea at the
point D, Plate 9, when this thyroid vessel arises directly from the arch
of the aorta, between the roots of the innominate and left common
carotid, or when it springs from the innominate itself. The inferior
thyroid vein, sometimes single and sometimes double, overlies the
trachea at the point D, Plate 9, when this vein opens into the left
innominate venous trunk, as this latter crosses over the root of the
main arteries springing from the aorta.
Laryngotomy is, anatomically considered, a far less dangerous operation
than tracheotomy, for the above-named reasons; and the former should
always be preferred when particular circumstances do not render the
latter operation absolutely necessary. In addition to the fact, that the
carotid arteries lie farther apart from each other and from the median
place--viz., the crico-thyroid interval, which is the seat of
laryngotomy--than they do lower down on either side of the trachea, it
should also be noticed that the tracheal tube being more moveable than
the larynx, is hence more liable to swerve from the cutting instrument,
and implicate the vessels. Tracheotomy on the infant is a far more
anxious proceeding than the same operation performed on the adult;
because the trachea in the infant's body lies more closely within the
embrace of the carotid arteries, is less in diameter, shorter, and more
mobile than in the adult body.
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