. American practice of surgery ; a complete system of the science and art of surgery . hain which areUsually First Enlarged. (Armals of Surgery, July, 1905.) about the location of the facial artery, and is finally inserted into the depressorlabii inferioris (quadratus menti). When this nerve filament is cut, a very awkward paralysis of the mouthresults, which is shown, in the accompanying photograph (Fig. 177). The trans-verse incision should, therefore, be made at least a fingers breadth below the * Jaffe: Isolirte Lahmung des Musculus Quadratus Menti, etc., in Archiv fur klin. Chir.,Ixvii.,
. American practice of surgery ; a complete system of the science and art of surgery . hain which areUsually First Enlarged. (Armals of Surgery, July, 1905.) about the location of the facial artery, and is finally inserted into the depressorlabii inferioris (quadratus menti). When this nerve filament is cut, a very awkward paralysis of the mouthresults, which is shown, in the accompanying photograph (Fig. 177). The trans-verse incision should, therefore, be made at least a fingers breadth below the * Jaffe: Isolirte Lahmung des Musculus Quadratus Menti, etc., in Archiv fur klin. Chir.,Ixvii., p. 736. t Bockenheimer, in Langenbecks Archives, Band Ixxii., p. 461. 552 AMERICAN PRACTICE OF SURGERY. angle of the jaw. It should then be carried through the platysma and deepfascia, which should be retracted upward, carrying the nerve which lies betweenthese structures. In more than forty operations which the ^^Titer has clone inthis way with this particular paralysis in mind, there has been no permanentevidence of nerve injury. Even when the nerve is cut, it often reunites, but. Fig. 175.—Two Incisions which Give Access to a Large Part of the Neck and Leave only FaintScars Above the Line of the Collar. The lower incision gives access from behind if the nodes underthe stemo-mastoid muscle are not removed through the upper one. (Annals of Surgery, July, 1905.) the number of paralyses which one sees in patients whose necks have beenoperated upon indicates that this nerve injury has frequently been spiTial accessory nerve runs directly through the group of lymph nodeswhich are most frequently enlarged, and it should be guarded with the great-est care during their removal. If this bunch of nodes is removed en masse the SURGICAL DISEASES OF THE LYMPHATICS. 553 nerve must be taken with them. Therefore, a most painstaking separation ofthe nodes must be made until the nerve is detected. It emerges from the jugu-lar foramen, close to the spinous process, and passes in
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