A manual of otology for students and practitioners . ly above the clavicle to nearthe angle of the mandible, and extends through the skin,superficial fascia and platysma myoides, and usuallyreveals the fibers of the sternomastoid muscle. If it doesnot, this muscle should be sought by pushing back theposterior margin of the wound with the handle of thescalpel. Having located the anterior border of thismuscle, it is held back with a blunt retractor. An anteriorretractor is not advised, as the relation of the parts is oftenobscured by its use. Throughout the rest of the operationblunt dissection
A manual of otology for students and practitioners . ly above the clavicle to nearthe angle of the mandible, and extends through the skin,superficial fascia and platysma myoides, and usuallyreveals the fibers of the sternomastoid muscle. If it doesnot, this muscle should be sought by pushing back theposterior margin of the wound with the handle of thescalpel. Having located the anterior border of thismuscle, it is held back with a blunt retractor. An anteriorretractor is not advised, as the relation of the parts is oftenobscured by its use. Throughout the rest of the operationblunt dissection is used. By retracting the sternomastoidmuscle, the sheath of the vessels is exposed. The veinlies external to the common carotid artery (Fig. 74) andbetween the two, but on a deeper level, the pneumogastric JUGULAR OPERATION 243 nerve. The nerve is not shown in the cut as it does notcome into view until a later stage in the operation. Atthe lower part of the incision passing over the sheath,and therefore superficial to the vessels, is the anterior. Fig. 74.—The vein and artery exposed in the operation for jugularexcision. The pneumogastric nerve does not show, as it is covered bythe artery and the vein. belly of the homohyoid muscle. Lying in the sheathsuperficial to the vessels is the decendens may at times be seen but no attempt to preserveit is made. If from the appearance of the vein or anyother reason a low resection is determined upon, the 244 SINUS THROMBOSIS homohyoid muscle may be divided on a grooved sheath of the vessels is merely a thin layer ofconnective tissue and requires no division. If one con-ceives this sheath as tissue which must be passed throughbefore coming in contact with the vein, he will oftenenter the vein in trying to do this. Disregarding thesheath, the vein is separated (with the handle of thescalpel) from the other structures with which it is asso-ciated. The artery is not disturbed as its location mayreadily be det
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