. Manual of operative surgery. er border of the sterno-mastoid outwards and ex-pose the omo-hyoid. Retract the omo-hyoid upwards and inwards. Underthe omo-hyoid lies the upper pole of the thyroid. Step 3.—Pass a ligature (Unen, silk) round the upper pole and tie it (). If a vein is pierced by the aneurysm needle and causes bleeding pullupon the ligature and pass a second ligature including more tissue. Theligature includes veins, arteries, and gland tissue. There is no danger ofinjuring the recurrent laryngeal nerve (Mayo, Annals of Surg., Dec, 1909). Stamm and Jacobson strongly recomm
. Manual of operative surgery. er border of the sterno-mastoid outwards and ex-pose the omo-hyoid. Retract the omo-hyoid upwards and inwards. Underthe omo-hyoid lies the upper pole of the thyroid. Step 3.—Pass a ligature (Unen, silk) round the upper pole and tie it (). If a vein is pierced by the aneurysm needle and causes bleeding pullupon the ligature and pass a second ligature including more tissue. Theligature includes veins, arteries, and gland tissue. There is no danger ofinjuring the recurrent laryngeal nerve (Mayo, Annals of Surg., Dec, 1909). Stamm and Jacobson strongly recommend ligation of the upper pole in ex- INFERIOR THYROID 845 ophthalmic goitre when more radical operations seem inadvisable. The authorfinds the operation by no means difficult. Inferior Th)a-oid Artery.—Step i.—Expose the common carotid artery andinternal jugular vein immediately below the tendon of the omo-hyoid. (Dothis either through Kochers incision or through an incision along the innermargin of the sterno-mastoid).. Fig. 1004.—Ligation of superior pole of thyroid. {Mayo, Annals of Surgery.) Step —Gently retract outwards the carotid packet of vessels and the tendon of the omo-hyoid upwards. Push the thyroid gland and thetrachea inwards {, towards the opposite side). Note the transverse process of the sixth cervical vertebra (carotid tubercle).Opposite this fixed point the inferior thyroid artery may be seen appearing frombehind the common carotid at about the same level as the omo-hyoid tendoncrosses in front of that vessel. 846 LIGATION OF ARTERIES IN CONTINUITY Step 3.—^I>igale the artery as far from the thyroid gland as possible to avoidinjury to the recurrent laryngeal nerve which crosses the artery behind the careful not to include in the ligation the middle cervical ganglion or therecurrent laryngeal nerve. The indications for ligation of the inferior thyroid artery (and for thesuperior as well) are certain forms of goitre.
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