Surgical therapeutics and operative technique . of the neck respectively. Moredeeply will be observed the course of a tuberculous osteitis of the body andlateral portions of a vertebra which has established an opening into theoesophagus. \ In this section the position of the principal groups of glands can berecognized—-the external, anterior, and posterior groups of the carotidchain; and the nuchal group of glands—the so-called Ricords gland—from VOL. II. 11 J62 SURGICAL THERAPEUTICS AND OPERATIVE TECHNIQUE the importance of examination of the retro-mastoid region in which they aresituated, in
Surgical therapeutics and operative technique . of the neck respectively. Moredeeply will be observed the course of a tuberculous osteitis of the body andlateral portions of a vertebra which has established an opening into theoesophagus. \ In this section the position of the principal groups of glands can berecognized—-the external, anterior, and posterior groups of the carotidchain; and the nuchal group of glands—the so-called Ricords gland—from VOL. II. 11 J62 SURGICAL THERAPEUTICS AND OPERATIVE TECHNIQUE the importance of examination of the retro-mastoid region in which they aresituated, in order to confirm the diagnosis of secondary or tertiary syphilis. All phlegmons of the neck should be treated by early incision, in order toprevent purulent infiltration. Administration of mycolysine, both by themouth and hypodermically, should also be resorted to, as this remedy canby itself secure resolution in some cases. Operation.—Median and lateral subhyoid phlegmon must be dealt withby vertical incision. We operate as follows:. Fig. 277. -Subcutaneous Phlegmon: Median and Right Lateral,Subaponeurotic Phlegmon. Focus of tliyroid suppuration; adenitis of anterior carotid glands on left side, and ofexternal carotid glands on the right. Also on this side: Phlegmon of posteriorcarotid glands, displacing the vasculo-nervous bundle. Behind: Adenitis ofposterior cervical glands; ossifluent abscess of a vertebral opening in front of theoesophagus; revolver bullet flattened against a vertebral lamina. First Stage: Incision of the Skin.—Subcutaneous plilegmons areattacked at the most projecting point. Wound of a superficial vein is rare;when it occurs a ligature is applied. Phlegmons situated beneath the middleaponeurosis are also opened at the most projecting point. Phlegmons of thecarotid glands should be attacked according to the group involved—frombefore, or behind, the sterno-mastoid muscle; sometimes even through itssubstance, when the muscular fasciculi have bee
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