Operative surgery . ssment and leadto harmful delay. Theapplication of the liga-ture to the thyroid ves-sels at a distance fromthe growth, or the use)f temporary ligatures,should be prac-ticed when prop-er isolation ofthe recurrentlaryngeal nerveis not the sepa-ration of the goi-tre from the trachea therecurrentlaryngealnervemay be injured in spiteof every care, especial-ly where it passes be-neath the lower borderof the larynx. To pre-vent this accident Koch-er advises that a poste-rior portion of the capsule of the growth be cut away and left behind at thatsituation. In instan
Operative surgery . ssment and leadto harmful delay. Theapplication of the liga-ture to the thyroid ves-sels at a distance fromthe growth, or the use)f temporary ligatures,should be prac-ticed when prop-er isolation ofthe recurrentlaryngeal nerveis not the sepa-ration of the goi-tre from the trachea therecurrentlaryngealnervemay be injured in spiteof every care, especial-ly where it passes be-neath the lower borderof the larynx. To pre-vent this accident Koch-er advises that a poste-rior portion of the capsule of the growth be cut away and left behind at thatsituation. In instances of encapsulated thyroid nodules, not separable poste-riorly from the internal thyroid capsule, the capsule must be cut through,but not sufficiently near to the trachea to beget a dangerous removal. Thepossible adhesion of large growths to the jugular vein should not be over-looked. Undue compression upon or a kinking of the pressure-softenedtrachea by rough handling may cause alarming and perhaps fatal Fig. 1290.—The operatinii of excision df goitre of right sidethrough transverse incision (Fig. 1288), Kochers Superior thyroid artery and vein. h. Posterior bor-der of thyroid cartihige. c. Sterno-hyoid and sterno-thyroid muscles, d. Sterno-cleido-niastoid muscle, thvroid artery. /. Right common carotidartery, g. Right recurrent laryngeal nerve. 1\. QCsopli-agus. i. Trachea. _;. Inferior thyroid vein. A\ Righthalf of goitre turned out toward the left side. (>1i;i;a1|(>ns on iiik xkck. Kiiil ^^
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Keywords: ., bo, bookcentury1800, bookdecade1890, bookidoperativesurgery02brya
