Surgical treatment; a practical treatise on the therapy of surgical diseases for the use of practitioners and students of surgery . is most important chain of glands, the internaljugular vein must be removed. A less wide exposure is secured by carrying an incision from the mastoidprocess to the sternoclavicular joint along the anterior border of the sterno-mastoid muscle, and a second incision from the bottom of the symphysis of thelower jaw downward and backward to meet the first incision at the level ofthe upper border of the thyroid cartilage (Fig. 1064). The sternomastoidmuscle is cleaned
Surgical treatment; a practical treatise on the therapy of surgical diseases for the use of practitioners and students of surgery . is most important chain of glands, the internaljugular vein must be removed. A less wide exposure is secured by carrying an incision from the mastoidprocess to the sternoclavicular joint along the anterior border of the sterno-mastoid muscle, and a second incision from the bottom of the symphysis of thelower jaw downward and backward to meet the first incision at the level ofthe upper border of the thyroid cartilage (Fig. 1064). The sternomastoidmuscle is cleaned off and retracted backward. The anterior triangle is dis-sected out from below upward, followed by dissection of the digastric and sub-mental regions. In operating for cancer of the tongue the anesthetic is best administeredthrough two tubes passed to the pharynx through the nostrils, the back ofthe mouth being packed with gauze. Blood may be saved by temporarilyclamping the carotid low down and high up with soft arterial clamps. Thestructures of the neck are best removed in one mass. The common carotid 366 SURGICAL TREATMENT. Fig. 1065.—Double Flap Incision for Removing Lymphatics of the Neck in Opera-tion for Cancer of the Tongue. THE NECK 367 is exposed by an intermuscular incision above the clavicle, and the temporarysoft clamp applied. An incision is made below the lower jaw from the chinto the mastoid process. A second incision is begun at the angle of the jaw andcarried down to the junction of the inner and middle thirds of the clavicle(Fig. 1065). The flaps are reflected back to expose the anterior and digastrictriangles and submaxillary and internal jugular regions. The sternomaxil-lary muscle is divided near the clavicle; the internal and external jugularveins are tied at the base of the neck and divided. The dissection is thencarried upward, dissecting free everything external to the deep plane of the
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Keywords: ., bookcentury1900, bookdecade1920, booksubjectsurgery, bookyear1920
