Surgical treatment; a practical treatise on the therapy of surgical diseases for the use of practitioners and students of surgery . Fig. 1065.—Double Flap Incision for Removing Lymphatics of the Neck in Opera-tion for Cancer of the Tongue. THE NECK 367 is exposed by an intermuscular incision above the clavicle, and the temporarysoft clamp applied. An incision is made below the lower jaw from the chinto the mastoid process. A second incision is begun at the angle of the jaw andcarried down to the junction of the inner and middle thirds of the clavicle(Fig. 1065). The flaps are reflected back to
Surgical treatment; a practical treatise on the therapy of surgical diseases for the use of practitioners and students of surgery . Fig. 1065.—Double Flap Incision for Removing Lymphatics of the Neck in Opera-tion for Cancer of the Tongue. THE NECK 367 is exposed by an intermuscular incision above the clavicle, and the temporarysoft clamp applied. An incision is made below the lower jaw from the chinto the mastoid process. A second incision is begun at the angle of the jaw andcarried down to the junction of the inner and middle thirds of the clavicle(Fig. 1065). The flaps are reflected back to expose the anterior and digastrictriangles and submaxillary and internal jugular regions. The sternomaxil-lary muscle is divided near the clavicle; the internal and external jugularveins are tied at the base of the neck and divided. The dissection is thencarried upward, dissecting free everything external to the deep plane of the. Fig. 1066.—Dissection Upward of Lymphatics of towels or gauze protect the environment. The internal jugular vein has been dis-sected out with the glands and connective tissue. neck. All the fascia, the muscles, veins, fat and connective tissue are dis-sected free up to the floor of the mouth (Fig. 1066). If the operation is forcancer inside of the mouth, the jaw is then divided, and the diseased focusextirpated along with the cervical mass. The pneumogastric nerve is not in-jured. The clamps are removed from the carotid as soon as possible. Ifthe growth is not extensive and no operation is to be done in the mouth, thedissection may be made from above downward (Fig. 1067). The sterno-mastoid muscle may be preserved and sutured back in place, although its lossdoes not cause any considerable disturbance of function (Fig. 1068). In any of these operations if deeper structures are found involved indisease which must be removed to effect a cure they should be exci
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Keywords: ., bookcentury1900, bookdecade1920, booksubjectsurgery, bookyear1920
