132 Tracheotomy 



long ; it must be kept absolutely in the middle line and high up. ihe 

 lower down the neck that it is made, the deeper lies the trachea ; it 

 should, therefore, be begun over the lower border of the thyroid car- 

 tilage, and the surgeon should make it his object to open the very 

 highest rings of the trachea, and, if need be, the cricoid also. This 

 laryngo-tracheal operation does well in children, and, resorting to it, 

 the surgeon is certain to escape the dangers and difficulties which are 

 inseparable from the low operation. 



Thyroid Cartiltujr _^ 



Orioo-thyroifi Membrane 



9 ie Artery 

 Crusoid Cartilage. 

 Superior TJiyroid -vein 



Infer. TJiyroid 

 Ji.rtcri<t tnnominata 



Front of child's neck. (G RAY. ) 



The skin, superficial fascia, some tributaries of the anterior jugular 

 vein, and the deep fascia are divided. The narrow interval between 

 the sterno-hyoids is traversed with a director and forceps, and a second 

 layer of the deep fascia is then torn through. 



The trachea, having thus been denuded, is caught and fixed by a 

 sharp hook, and a knife is plunged through the second or third ring, 

 and, the edge being directed forwards, a sufficient opening is made in 

 the upward direction for the tube. In old people the trachea 1 rings 

 may be ossified. 



Though the surgeon prefers not to open the trachea until all bleed- 

 ing has been checked, he need not dread even free venous oozing ; for 

 as soon as air enters the lungs the right side of the heart empties itself 



