. Manual of operative surgery. s against this tissue, it appears as if coming directly through thewalls of the artery. I rub the point through with the finger or some instrument,and thread it, and withdraw the ligature with it. This seems to work moresatisfactorily than when it is threaded beforehand. j\ practical point of extreme value is to have the anaesthetist place his 842 LIGATION OF ARTERIES IN CONTIN^nTY finger upon the temporal artery, and the operator either cross or pull uponthe ligature, to see that it stops the circulation in the temporal. I know thisis important, because once whe
. Manual of operative surgery. s against this tissue, it appears as if coming directly through thewalls of the artery. I rub the point through with the finger or some instrument,and thread it, and withdraw the ligature with it. This seems to work moresatisfactorily than when it is threaded beforehand. j\ practical point of extreme value is to have the anaesthetist place his 842 LIGATION OF ARTERIES IN CONTIN^nTY finger upon the temporal artery, and the operator either cross or pull uponthe ligature, to see that it stops the circulation in the temporal. I know thisis important, because once when I did not take this precaution. I tied the in-ternal by Method B.—Kochers Incision.—Step i.—Choose a point on the anteriormargin of the sterno-mastoid muscle, one fingers breadth below the angle of thejaw. Make a sUghtly oblique incision horizontal having its centre at the abovepoint (Fig. 1002). After exposing the anterior edge of the sterno-mastoid theoperation becomes practically the same as Method acces-sory jug. V. Descendeos noni Int. jugularSterno-mastoid Hypoglossal nGaeater hornhyoidSup. laryn-geal carotidSup. thyroid art Fig. 1002.— of external carotid. (Kocher. Indicatioiis.—(a) Hemorrhage from wounds of branches. (6) As a preliminary step in the removal of some tumors, , of the retro-phar^mgeal space. (c) Aneurysm. ^ {d) Occasionally to prevent hemorrhage from the middle meningeal arteryduring operations on the Gasserian ganglion. Remarks.—Hearn ligates the external carotid as a preliminary to excisionof the superior maxilla for malignant disease, and states that in doing so heexposes some enlarged lymph nodes which would otherwise escape ligates both external carotids while excising the lymphatic areasbefore remong the cancerous tongue. \V. P. Nicolson strongly recommendssingle (if necessar\- double) ligation immediately before undertaking any facialor maxillary operation
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