484 Anatomy Applied to Medicine and Surge* y. 



the aurieularis magnus, while 'the internal carotid and in- 

 ternal jugular lie close to its under surface. Hence, a care- 

 less incision made into this gland might be productive of 

 serious results, but, fortunately, it may be opened by an in- 

 cision placed in front of the ramus of the jaw, since the 

 gland projects anteriorly, for a variable distance, over the 

 masseter muscle. The opening should not be made with- 

 in three-quarters of an inch of the zygoma, because of the 

 situation of the artery, duct and nerve which cross the side 

 of the face after leaving the gland. 



Tracheotomy. Although intubation has replaced 

 tracheotomy in many instances, yet occasions arise in 

 which the latter operation may have 'to be employed, and, 

 of the two operations that may be performed for the pur- 

 pose of opening the trachea, the "high," i.e., the one above 

 the isthmus of the thyroid gland, is the better. The fol- 

 lowing relations of the trachea, below the isthmus, ex- 

 plain the reasons for the selection of the "'high" operation ; 

 the transverse branches joining the anterior jugular veins 

 are larger, below, than above the isthmus ; the muscles 

 are in closer contact, and the presence of the inferior thy- 

 roid veins and the thyroidea ima artery add to the dangers 

 of the operation ; the great vessels o-f the neck are nearer 

 one another, and, hence, would be exposed to the danger 

 of being wounded ; besides, the left innominate vein often 

 crosses the root of the neck rather than the interior of the 

 thorax, and, lastly, the trachea is more deeply situated and 

 is more mobile in this situation than above. Operation. 

 An incision, about one or one and a half inches in length, 

 is made in the median line and with its upper end about 

 on a level with the upper border of the cricoid cartilage. 

 After dividing the skin, superficial fascia (taking care to 

 avoid the anterior jugular vein while incising the latter) 

 and the deep fascia, the intervals between the two sterno- 



