i68 



APPLIED ANATOMY. 



CUT THROAT. 



The most frequent site of the incision in cases of cut throat is between the hyoid 

 bone and thyroid cartilage. If above the hyoid bone, the incision will divide the 

 mylohyoid, geniohyoid, geniohyoglossus, and hyoglossus muscles, and perhaps the 

 digastric and stylohyoid. If it goes far back it may wound the submaxillary gland 

 or duct, the facial or lingual arteries and veins, and the hypoglossal nerve. The 

 commencement of the anterior jugular will certainly be divided and the external 

 jugular may also be wounded. The cut passes through the base of the tongue and the 

 upper portion of the epiglottis. The tip of the epiglottis is sometimes entirely cut off. 

 If in the thyrohyoid space, the incision passes a short distance above the vocal cords. 

 The sternohyoid, omohyoid, and thyrohyoid muscles are divided. If prolonged 

 backward the pharynx will be opened and perhaps the arytenoid cartilages wounded. 

 The superior thyroid artery is likely to be cut. This is the vessel most often divided 

 in suicidal wounds. The carotid arteries and internal jugular veins are deep and far 

 back, lying under the edge of the sternomastoid muscle, and are rarely wounded. 



4 



Sternohyoid muscle 



Sternothyroid muscle 



Thyroid gland 



Recurrent laryn- 

 geal nerve 



, Omohyoid muscle 



Inferior thyroid artery 

 Common carotid artery 



-Sternomastoid muscle 



Oesophagus 



FIG. 187. Exposing the oesophagus. 



If these are cut, death usually rapidly ensues from hemorrhage. The superior 

 laryngeal nerve may be injured as it pierces the thyrohyoid membrane. This nerve 

 is sensory and its division is followed by anaesthesia of that half of the larynx to 

 which it is distributed. This favors the entrance of food and liquids into the larynx 

 and so may cause a fatal septic pneumonia. If through the thyroid cartilage the 

 incision may wound the vocal cords. They lie just beneath the most prominent 

 part of the thyroid cartilage and just below its median notch. If through the trachea, 

 the incision may wound the thyroid gland, which reaches from about the sixth ring 

 of the trachea to the oblique line on the thyroid cartilage. 



Bleeding from the wounded thyroid, if the gland is normal in size, is not likely 

 to be excessive. Below the cricoid cartilage the oesophagus may be wounded, above 

 it the pharynx may be opened. The two large sternomastoid muscles being put on 

 the stretch tend to protect the large vessels beneath. Suppuration not infrequently 

 accompanies these wounds of the neck in which the air and food passages are in- 

 volved and may give rise to collections of pus which may travel between the fascias, as 

 previously described. In treatment it is customary to cleanse the wounds and approxi- 

 mate the various injured tissues as carefully as possible, and feed by a stomach tube. 



