. Manual of operative surgery. For thispurpose Fowler threw a tape around the vessel, securing the tape by forceps,while Crile successfully uses his special forceps. LIGATION OF INTERNAL JUGULAR VEIN Ligation of the vein may be necessary in cases of sigmoid sinus thrombosisThe operation is practically the same as for ligation of the carotid. Particularcare must be exercised in passing the ligature around the vein, as its walls arevery thin and its size varies greatly during expiration and inspiration. LIGATION OF THE CAROTID ARTERY Position of patient as in ligation of the common car
. Manual of operative surgery. For thispurpose Fowler threw a tape around the vessel, securing the tape by forceps,while Crile successfully uses his special forceps. LIGATION OF INTERNAL JUGULAR VEIN Ligation of the vein may be necessary in cases of sigmoid sinus thrombosisThe operation is practically the same as for ligation of the carotid. Particularcare must be exercised in passing the ligature around the vein, as its walls arevery thin and its size varies greatly during expiration and inspiration. LIGATION OF THE CAROTID ARTERY Position of patient as in ligation of the common carotid. Method A.—Step i.—Make an incision about 2^^ to 3 inches in lengthalong the anterior margin of the sterno-mastoid. The centre of the incisionmust be opposite the greater horn of the hyoid bone. Divide the platysma and Pharyngeal art. Lingual art. HyoglossusDigastric I Myo-hyoidTemporal art Int. max. art. x^Post, auric Stylo-hyoidDigastric Occipital art. Int. car. Ext. thyroid Com. car. Omo-hyoid. Sterno-thyroid Fig. iooo.—(Esinarch.) the deep fascia (attached to the sterno-mastoid) throughout the length of thewound. Retract the sterno-mastoid outwards. Siep 2.—Find the posterior belly of the digastric muscle in the upper part ofthe wound (Fig. 1000). Find the hypoglossal nerve a little below the digastric(Fig. 1001). Retract these structures upwards. Avoid injuring the facial andsuperior thyroid veins. EXTERNAL CAROTID 841 Note the tip of the great cornu of the hyoid bone and expose the arteryopposite this guide. As the internal carotid has been mistaken for the external,it is very wise to demonstrate one of the branches of the external carotid beforepassing a ligature around the vessel. Step 3.—Pass a ligature around the vessel from without inwards, avoidingthe vein which Hes to the outer side of, and frequently overlaps the vessel, andalso avoiding the superior laryngeal nerve which runs behind it.
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