THE NECK. 



167 



inward and upward behind the common carotid artery to reach the groove between 

 the trachea and oesophagus in which it ascends to the larynx. 



On the left side the recurrent laryngeal nerve winds around the arch of the aorta 

 and ascends in the groove on the left side between the trachea and oesophagus. The 

 left carotid artery is closer to the oesophagus than the right. The narrowest point of 

 the lumen is at the cricoid cartilage. Its next narrow point is where it crosses the aorta 

 and left bronchus. This is opposite the upper part of the second piece of the sternum 

 or the upper border of the fifth thoracic vertebra. The third narrow portion is the 

 cardiac opening into the stomach. Mouton (Tillaux, "Anat. Topograph. ," p. 418) 

 gives the diameter of the oesophagus at each of these three points as 14 mm. 



Foreign Bodies. Foreign bodies if they pass the cricoid cartilage are most 

 liable to stop at the aorta and the left bronchus. This is opposite the angle of Ludwig 



Left common 

 carotid arte 



Vagus nerve 



Internal jugula 

 vei: 



Inferior thyroii 

 arter 



Vertebral artery 



Thoracic duct 



Phrenic nervi 

 Recurrent laryn 

 geal nervi 

 Subclavian 

 artery- 

 Bronchial artery. 



Pulmonary artery 

 Left vagus nerve 



Internal jugular 

 vein 



Vagus nerve 

 Common carotid 

 artery 



Inf. thyroid artery 

 Vertebral artery 

 Trachea 



Recurrent laryn- 

 geal nerve 

 CEsophagus 

 Vagus nerve 

 Phrenic nerve 

 Vena azygos 

 major 

 Right bronchus 



Right pulmonary 

 artery 



Pulmonary vein 



FIG. 186. Relations of the cervical portion of the ossophagus, viewed posteriorly. 



and the second rib, so that the foreign body is either at the root of the neck or just 

 below the top of the sternum. If it passes the two upper constrictions it will prob- 

 ably pass the third, because the cardiac constriction is caused by the diaphragm, which 

 relaxes and allows the body to enter the stomach. 



CEsophagotomy. In operating, an incision is made along the anterior border 

 of the left sternomastoid muscle from the sternoclavicular joint upward. The anterior 

 jugular vein will be cut. After opening the deep fascia the sternomastoid is to be 

 pulled outward. The omohyoid is to be drawn up and out and also the lower por- 

 tion of the sternohyoid and perhaps the sternothyroid. 



The middle thyroid and perhaps .an accessory thyroid vein are divided and the 

 thyroid gland and trachea drawn inward. The trachea is to be identified by the 

 sense of touch. The inferior thyroid artery is behind the sheath of the vessels and is 

 so high that it is not likely to be injured. The recurrent laryngeal nerve must be 

 looked for between the oesophagus and trachea, and avoided. In going deep down 

 care must be taken not to injure the innominate vein, which comes well up towards the 

 top of the sternum. 



