. Operative surgery. e the small venous trunks which runacross the tracheal and laryngeal region,without any definitely established relation-ship, and which return their blood chieflyinto the superior thyroid veins (Fig. 863).The anterior jugular veins will be trouble-some unless the median line be adhered to closely. It is unnecessary, I trust,to allude to the well-known relation between the larynx and the large vesselsof the neck. The thymus gland in the very young deserves respectfulmanipulative consideration. The innominate and common carotid arteries,especially in the right, may encroach
. Operative surgery. e the small venous trunks which runacross the tracheal and laryngeal region,without any definitely established relation-ship, and which return their blood chieflyinto the superior thyroid veins (Fig. 863).The anterior jugular veins will be trouble-some unless the median line be adhered to closely. It is unnecessary, I trust,to allude to the well-known relation between the larynx and the large vesselsof the neck. The thymus gland in the very young deserves respectfulmanipulative consideration. The innominate and common carotid arteries,especially in the right, may encroach on the operation in low tracheotomy. The ancBstlietic to be given in operations where the respiratory functionof the larynx is involved is a matter entitled to careful consideration. Forinstance, if ether be given to one who has no laryngeal irritation or obstruc-tion, the frequent spasm of those parts is familiar to all. If to this be addedthe deficient aeration of the blood, due to a laryngeal obstruction, together. Fig. 863.—The topography of thelarynx, etc. a. Body of hyoidbone. h. Thyro-hyoid membrane,c. Thyroid cartilage, d. Crico-thyroid membrane. e. Cricoidcartilage. /. First tracheal Isthmus of thyroid body, withtracheal rings below, h. Crico-thyroid muscle. OPERATIONS ON THE NECK. 683
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