APPLIED ANATOMY. 



gastric nerve, and the middle ganglion of the sympathetic. The recurrent laryngeal 

 nerve usually passes upward behind the branches of the artery just before they enter 

 the thyroid gland. The thoracic duct on the left side passes over the front of the 

 artery low down. 



Operation. An incision 7.5 cm. long is made along the anterior border of the 

 sternomastoid muscle, extending upward from the clavicle. This will bring the upper 

 extremity up to, or even above, the cricoid cartilage. The anterior jugular vein 

 will have to be ligated and the muscle displaced outward. The common carotid 

 artery should then be isolated and it, together with the pneumogastric nerve and 

 internal jugular vein, drawn outward. The omohyoid muscle may appear at the 

 upper edge of the incision. Feel for the carotid tubercle on the sixth transverse 

 cervical process: the artery lies below the omohyoid muscle and cricoid cartilage and 

 below the tubercle and beneath the sheath of the carotid. If the trunk of the sym- 

 pathetic or its middle cervical ganglion, which lies on the artery, is encountered, it 



Profunda cervicis 

 Transverse cervical 



Posterior scapular 



Acromial thoracic 



Subscapular 

 Dorsalis scapulae 



Long thoracic 



Inferior thyroid 

 Common carotid 

 Vertebral 

 Innominate 



Superior intercostal 

 Subclavian 

 Superior thoracic 

 Internal mammary 



FIG. 176. Collateral circulation after ligation of the third portion of the subclavian artery. 



should be pushed to the inner side, the artery isolated outwardly and ligature applied. 

 Do not go too far out or the scalenus anticus will be reached and the phrenic nerve 

 may be injured, nor too far in, to avoid wounding the recurrent laryngeal. 



The thyroidea ima (inferior thyroid} veins do not cross outward nor accompany 

 the artery, but proceed downward on the trachea to empty into the innominate veins. 



THE CERVICAL FASCIAS. 



There are two fascias in the neck, the superficial and the deep. The super- 

 ficial fascia has blended with it anteriorly the platysma muscle and the termination of 

 the nerves, arteries, and veins. The main trunks of these structures lie for all 

 practical purposes beneath the superficial fascia and adherent to the surface of the 

 deep fascia. It is for this reason that in raising the superficial structures the larger 

 trunks remain applied to the deep fascia and are thus less liable to be injured in the 

 living and mutilated in the dead. In the superficial fascia and on the deep fascia are 

 the superficial lymphatics. 



