62 TOPOGRAPHIC AND APPLIED ANATOMY. 



PLATE 5. 

 A cross-section of the neck at the level of the thyroid cartilage. Frozen section. 



border of the trapezius muscle, the more or less deep fossa supraclavicularis major above the 

 clavicle, the jugular fossa above the upper margin of the sternum, and the fossa supraclavicularis 

 minor, which is distinctly seen above the sternoclavicular articulation only when there is a marked 

 interspace between the two heads of the sternocleidomastoid muscle. The latter is one of the 

 rarer situations for ligating the common carotid artery (according to Zang) and the area for aus- 

 cultating venous murmurs in the internal jugular vein. The external jugular vein, visible 

 through the skin when well filled, may be distinctly outlined by making compression upon its 

 terminal portion at the outer side of the sternocleidomastoid muscle [just above the clavicle. 

 ED.]. This causes the vein to become greatly distended, and it may consequently be avoided in 

 operative procedures upon the neck. 



The palpation of those portions of the respiratory apparatus which are situated anteriorly 

 is of particular importance. Starting at the angle of the thyroid cartilage (pomum adami) at the 

 incisura thyroidea superior, the hyoid bone may be palpated posteriorly as far as the greater 

 cornua, and the hyoid bone should be distinctly differentiated from the upper border of the thyroid 

 cartilage by placing the thumb and index-finger of one hand upon the region overlying the thyro- 

 hyoid membrane. Below the thyroid notch may be felt the blunt anterior edge of the thyroid 

 cartilage leading downward to the ring of the cricoid cartilage, which is connected to the thyroid 

 cartilage by means of the rigid and distinct middle cricothyroid ligament (ligamentum conicum). 

 Below the cricoid cartilage is the first tracheal ring, and still lower down, provided that it is well 

 developed, the isthmus 0} the thyroid gland may be palpated. The pulsations of the common 

 carotid artery may be easily felt beside the larynx at the inner border of the sternocleidomastoid 

 muscle. The subclavian artery is deeply situated in the larger supraclavicular fossa; the vessel 

 runs over the first rib and its pulsations are not always to be distinctly palpated. If the arm is 

 drawn downward, the subclavian artery may be compressed against the first rib for the purpose 

 of avoiding or controlling hemorrhage from a more peripheral region. 



As is shown by a cross-section (Plate 5), the soft parts of the neck are arranged in such a 

 manner that the supporting framework of the cervical vertebras is surrounded by muscles, the 

 great mass of which is located posterior to the vertebral column, while anteriorly there are only 

 the weak preveriebral and the scalene muscles. This osseous and muscular mass is covered by 

 the prevertebral fascia and united by a loose connective tissue with the so-called vascular and 

 visceral columns, which are almost completely covered in by the anterior cervical muscles (the 

 sternocleidomastoid and the hyoid muscles). The single viscera of the visceral column, com- 

 posed of the cervical portions of the digestive and respiratory tracts (the pharynx and esophagus, 

 the larynx with the hyoid bone and trachea), are situated in the median line between the paired 

 vascular columns, consisting of the carotid artery and the internal jugular vein together with the 

 vagus nerve. This grouping of the soft parts forms the foundation for the further comprehension 

 of this region. The visceral column, as the reader may readily discover in his own neck, is easily 

 moved upon the anterior surface of the vertebral column. Tumors situated in the lateral 

 portions of the neck consequently easily displace the larynx, the trachea, and the esophagus 



