Operative surgery, for students and practitioners . that separates the vessels from the sterno-mastoidmuscle,—the vessels, surrounded by some loose connective tissue, areexposed—first, the internal jugular vein, big and thin-walled, lyingto the outer side of the artery, and then the common carotid, whosepulsation is readily felt and seen and which lies to the inner sideof the vein. The pneumogastric nerve, which is located between OPERATIONS UPON THE NECK. 231 the artery and vein, but behind them, is not seen. The anterior bellyof the omo-hyoid is seen as it crosses the vessels opposite the cr
Operative surgery, for students and practitioners . that separates the vessels from the sterno-mastoidmuscle,—the vessels, surrounded by some loose connective tissue, areexposed—first, the internal jugular vein, big and thin-walled, lyingto the outer side of the artery, and then the common carotid, whosepulsation is readily felt and seen and which lies to the inner sideof the vein. The pneumogastric nerve, which is located between OPERATIONS UPON THE NECK. 231 the artery and vein, but behind them, is not seen. The anterior bellyof the omo-hyoid is seen as it crosses the vessels opposite the cricoidcartilage. The loop formed by the descendens and communicans nonimay also be recognized upon the front of the vessels. The superiorthyroid vein crosses the artery from within outward above the omo-hyoid muscle, and the middle thyroid vein below this muscle. Ifthese vessels are cut, they should be clamped and tied. The connective-tissue sheath which incloses the artery shouldbe picked up with mouse-tooth forceps, and nicked with the point. Fig. 138.—A, incision for removal of lower jaw; B, Incision for ligation oflingual artery and Kochers amputation of tongue; C, incision for ligation ofcommon carotid and for oesophagotomy. of the knife in the direction of the long axis of the vessels; into theopening thus made, a director is introduced, and, working close toits wall, the vessel is separated all around, taking care to avoid thepneumogastric nerve, which lies posteriorly. A blunt-pointed aneurismneedle is then introduced into the opening and carried around theartery from without inward, entering between the artery and thevein. The ligature is then drawn around the vessel, and we are readyto tie. The ligature should be of ordinary catgiit and tied with asquare knot. After the ligature is in place and before it is tied the 232 ? NECK AND TONGUE. parts should be again inspected in order to make sure that the nerveis not included. Some surgeons tie the artery double and d
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