88 SURGICAL ANATOMY OF THE 



pharyngeal nerve, and that portion of the parotid gland 

 which separates it from the internal carotid. 



Internally: Hyoid bone, pharynx, parotid, ramus of 

 jaw, and stylo-maxillary ligament. 



Internal Carotid Artery (cervical portion). Arises op- 

 posite the upper border of the thyroid cartilage, and is 

 at first superficial and external to the external carotid, 

 until the crossing of the digastric, where it becomes 

 deeper and lies beneath the external carotid. Usually 

 it gives off no branches in the neck, and is larger than 

 the external in the child, but of much the same calibre 

 in the adult. 



Relations of the Cervical Portion of the Internal Carotid. 

 In front: Integument and platysma, sterno-mastoid, 

 parotid, hypoglossal nerve, styloid process, stylo-glossus, 

 and stylo-pharyngeus muscles, glosso-pharyngeal nerve 

 and its branches. 



Externally: Internal jugular vein, and vagus nerve. 



Internally: Pharynx, ascending pharyngeal artery. 



Behind: Rectus anticus major muscle, sympathetic, 

 and superior laryngeal nerves. 



This region is the seat of most important operations 

 viz., ligature of the common carotid arteries or their 

 branches, of the subclavian in the first part of its course, 

 of the innominata, of O3sophagotomy, the removal of 

 tumors, and opening of abscesses. 



Ligature of the Common Carotid Artery. In applying 

 a ligature to the common carotid, that portion of it 

 which lies either immediately above or immediately be- 

 low the crossing of the omo-hyoid should be selected, as 

 the vessel is there most easily reached. 



Above the Omo-hyoid. The incision to be made varies 

 in length, according to the nature of the case, and the 



