A manual of operative surgery . The after-treatment is such that the procedureis but indifferently suited to hospital practice ; and although admir-able results have been claimed for the operation, still many examplesof relapse are forthcoming. Division of the Sterno-Mastoid Muscle.—This muscle, or aportion of it, is divided just above its origin in certain cases ofwry-neck. Sometimes division of the sternal tendon of the musclesuffices. The tenotomy is best carried out about one-fourth of an inchabove the upper border of the clavicle and sternum. The sterno-mastoid is in this situation covere
A manual of operative surgery . The after-treatment is such that the procedureis but indifferently suited to hospital practice ; and although admir-able results have been claimed for the operation, still many examplesof relapse are forthcoming. Division of the Sterno-Mastoid Muscle.—This muscle, or aportion of it, is divided just above its origin in certain cases ofwry-neck. Sometimes division of the sternal tendon of the musclesuffices. The tenotomy is best carried out about one-fourth of an inchabove the upper border of the clavicle and sternum. The sterno-mastoid is in this situation covered by the cervicalfascia, and is crossed by the suprasternal nerve. The anterior jugularvein passes behind it, just above the clavicle, and is in danger of beingwounded. This vein is, moreover, subject to considerable external jugular vein is in close relation with the posterior orouter border of the muscle. To obtain the best result in operating for wry-neck it is essential 802 OPERATIONS ON TENDONS [PART VIII. to divide not only the muscle, but also its contracted sheath. Thesternal portion of the muscle usually appears to be more con-tracted than the clavicular, but it will almost always be found neces-sary to divide both. The division should be carried out a short dis-tance above the clavicle, and not close to that bone, and it should be done by the open method, forby this procedure alone is itpossible to divide the muscleand fascia completely withoutrisk of injury to the veins. It will be rememberedthat three important veinsare in close relation to thesheath of the muscle—namely,the internal jugular to itsdeep surface, the externaljugular to its posterior borderat this level, and the anteriorjugular to its inner edge anddeep surface. The subclavianand the beginning of the in-nominate veins are also verynear its extremity. As severaldisasters have occurred frompuncture of one or other ofthese veins in subcutaneoustenotomy, and as aseptic precautions do away
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