HEAD AND NECK IN SECTION 21 



On the outer aspect of the levator anguU scapulae is the spinal 

 accessory nerve, which is cut through as it is ascending from the deep 

 face of the mastoido-humeralis (along which it has descended the 

 neck) to the trapezius muscle where the nerve terminates. 



The vertebral artery is severed as it passes forwards to run 

 across the interior aspect of the transverse process of this particular 

 vertebra, and in this connection it may be mentioned that this 

 transverse process is not pierced by a vertebral foramen. Accom- 

 panying the artery is the vertebral vein, whilst covering the artery 

 and vein is the scalenus muscle, which spreads out inferiorly over the 

 longus colli and oesophagus on the left side, whilst on the right side 

 it touches the trachea. Outwardly this muscle is related from above 

 downwards to the inferior border of the levator anguli scapula, to the 

 thin strap-like subscapulo-hyoideus muscle, and below this to the 

 mastoido-humeralis. On the inferior border of the subscapulo-hyoideus 

 is placed the inferior cervical artery, which is related inwardly to the 

 scalenus and outwardly to the mastoido-humeralis. 



The longus colli muscle is represented by a thick band which 

 runs along the inferior aspect of the vertebral centra. In this part 

 of the neck it is related inferiorly to the trachea, and on the left 

 side to the oesophagus also, but as we ascend the neck, as has been 

 already stated, the cesophagus ascends to the upper aspect of the 

 trachea and insinuates itself between the muscle and the windpipe. 



It is important to note the position of the oesophagus in this 

 section, in connection with the performance of the operation of 

 cesophagotomy. To reach the oesophagus from the exterior, it will 

 be seen that it is necessary to incise the skin and paniiiculus slightly 

 above the ridge indicated by the raised jugular vein. The fingers 

 should then be passed over the vein, breaking down the loose 

 connective tissue. By raising the thin inferior border of the 

 scalenus muscle, which spreads over the oesophagus, the latter is 

 exposed. 



