. The diseases of children : medical and surgical. val between the two heads, andits edge turned forward against each insuccession, the childs head beingheld stretched by an assistant. Caremust, of course, be taken not to wound the anterior jugular vein at the frontedge of the muscle, or the external jugular at the posterior border, nor tocarry the knife so deeply as to endanger the carotid sheath. We usuallydivide the muscle through an open incision, and where the cervical fascia isalso tightly contracted it is necessary to divide it, and in such cases it iscertainly safer to make an incision
. The diseases of children : medical and surgical. val between the two heads, andits edge turned forward against each insuccession, the childs head beingheld stretched by an assistant. Caremust, of course, be taken not to wound the anterior jugular vein at the frontedge of the muscle, or the external jugular at the posterior border, nor tocarry the knife so deeply as to endanger the carotid sheath. We usuallydivide the muscle through an open incision, and where the cervical fascia isalso tightly contracted it is necessary to divide it, and in such cases it iscertainly safer to make an incision over the muscle and gradually dissectthrough the rigid parts in an open wound. Some surgeons prefer to dividethe muscle at its middle. Two days after the tenotomy the apparatus(fig. 182) recommended by Mr. Southam should be applied. The followingcase is characteristic: Case. — Torticollis.—John Wm. G., age 5 years ; admitted August 5, 1885. A neuroticfamily history ; the child has never been strong ; the deformity is congenital, but has bean. Fig. 181.—Congenital Wry-neck. 1 Guys Reports, 1890; f/^/t? also Murray, Liverpool Med. Chir. Jour. July 1892. 742 Club-foot, Deformities of Limbs, drc. getting worse lately, and is increased when the child is not well ; has lately had toothacheon the left side. On admission the left sterno-mastoid is contracted in its whole extent,forming a firm prominent band ; the interval between the tendons is deeply marked, thesternal tendon being the most prominent. The chin is rotated i^ inch from the middleline downwards and to the right; the platysma is also prominent. August 13, tenotomyof both heads through the interval; the cervical fascia was also partially divided. Anti-septic operation and wood-wool dressing. 14th, no pain ; the head was packed in sand-bags. 17th, a plaster-of-Paris jacket was put on with hooks fixed in it, and a rubbermuscle was apphed parallel to the right sterno-mastoid, attached to the head by circular bands of s
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