THE (ESOPHAGUS IN THE NECK. 101 



Great care must be taken, in passing bougies or tubes 

 through the mouth into the oesophagus, to keep the end 

 of the instrument well against the spine, and to use very 

 gentle pressure, as false passages are readily made (es- 

 pecially where there has been any disease) into the pleural 

 cavity, posterior mediastinum, or pericardium. 



The operation of cesophagotomy is thus performed. An 

 incision is to be made on the left side of the neck, about 

 four inches long, along the anterior border of the sterno- 

 mastoid, as though for ligaturing the common carotid 

 artery above the crossing of the omo-hyoid. The omo- 

 hyoid, sterno-hyoid, and sterno-thyroid muscles are to 

 be drawn downwards and inwards, and the sheath of 

 the vessels, uninvolved, drawn outwards ; the oesophagus 

 is then seen at the bottom of the wound, when a longi- 

 tudinal incision is to be made upon the foreign body or 

 bougie as it lies in the tube. 



The structures to be avoided are the sheath of the 

 vessels, the thyroid vessels, the thyroid body, and the 

 laryngeal nerves. 



The occipital portion of the side of the neck, that above 

 the crossing of the omo-hyoid, possesses few points of 

 surgical importance beyond it being the seat of tumors. 

 Its boundaries are in front, the stern o-mastoid ; behind, 

 the trapezius ; and below, the omo-hyoid ; its floor is 

 formed by the upper portion of the anterior scalene 

 muscle, the middle and posterior scalene, the levator 

 anguli scapulae and splenius colli muscles. The spinal 

 accessory nerve emerges from the junction of the upper 

 and middle third of the posterior border of the sterno- 

 mastoid and crosses the region obliquely, to enter the 

 trapezius, accompanied by descending muscular branches 

 of the cervical plexus ; the superficial branches of the 



