Chap, ix.] THE NECK. 163 



subsequent disease of the spinal cord. Carcinoma of 

 the gullet, also, when it spreads, is apt to invade ad- 

 jacent parts, and especially to open into the trachea or 

 bronchi If it spreads to the pleura, it will usually 

 involve the right pleura, as being the membrane more 

 in relation with the gullet. Cancer of the .gullet 

 has so spread as to invade the thyroid body, the 

 pericardium, and the lung, and has opened up the 

 first intercostal artery in one case, and the right sub- 

 clavian in another (Butlin's " Sarcoma and Carcinoma," 

 1882). 



The operation of cesoplmgotomy consists in 

 incising the gullet for the purpose of removing an 

 impacted foreign body. The gullet is usually reached 

 from the left side, since it projects more on that 

 aspect. The incision is made between the sterno- 

 mastoid and the trachea, in the same direction as the 

 incision for ligaturing the common carotid. The cut 

 extends from the top of the thyroid cartilage to the 

 sterno-clavicular joint. The omo-hyoid muscle is 

 drawn outwards, or cut. The great vessels, larynx 

 and thyroid gland, are drawn aside, and care must 

 be taken not to wound these structures nor damage 

 the thyroid vessels or the recurrent nerve. The 

 gullet, when exposed, is opened by a vertical inci- 

 sion. 



In cesopliagostomy an opening is made into 

 the gullet through a like incision in cases of stricture 

 of the tube high up, the object being to feed the 

 patient through the opening made, in place of per- 

 forming gastrostomy. The risk, however, of setting 

 up severe diffuse inflammation in the loose planes of 

 connective tissue deep in the neck is very great, and 

 in some twenty-six cases in which the operation has 

 been already performed death has, in nearly all 

 instances, supervened at the end of a few hours or 

 days. 



