Fig. 66. Lateral Aspect of the Neck. Oesophagus. 



The outer region of the neck in a man, aged ^o, was exposed by a large window- 

 section. Platysma, Superficial Nerves, Facial Vein and lymphatic glands were 

 removed. The Sterno-Cleido-Mastoid Muscle was drawn backwards, the Thyreoid 

 Gland and the muscles near it forwards, in order to shew the Oesophagus (red). 

 The Sympathetic is white; the head is rotated to the right and inclined 



backwards. 



The Oesophagus lies between the Trachea and the Vertebral Column, 

 surrounded by loose conective tissue which allows its dilatation and movement 

 upwards and downwards. It begins at the 6th Cervical Vertebra (cf. Fig. i) and 

 passes downwards behind the Trachea, deviating somewhat to the left. This is 

 the reason why the left side is usually chosen for operating. An incision is made 

 along the Anterior border of the left Sterno-Mastoid Muscle between the level 

 of the Cricoid Cartilage and the Suprasternal Notch; after division of the Platysma 

 and Superficial Cervical Fascia, the Sterno-Mastoid is drawn outwards, and the Omo- 

 Hyoid Fascia divided, — also the Omo-Hyoid Muscle if it cannot be drawn 

 downwards. One now proceeds between the Carotid Artery, which is pulled out- 

 wards and the Thj'reoid Gland and the Sterno-Hyoid Muscle which cover it. When 

 the gland is very large, it may be necessary to remove the left lobe, in order to 

 have sufficient room. Deep in the wound, the Oesophagus can be recognised, 

 by its longitudinal pale red muscle fibres, in front of the vertebral column and 

 Longus Colli Muscle. The Oesophagus can be opened between the Superior and 

 Inferior Thyreoid Arteries; if it is desirable to open the Oesophagus at a lower 

 point, the Inferior Thyreoid Vessels are divided between a double ligature. In 

 order to avoid the Recurrent Laryngeal Nerve, the canal is opened along its outer 

 wall ; the cervical portion of the Oesophagus can thus be exposed, a stricture or 

 cancer removed, and an oesophageal fistula made by sewing the edges of the 

 lumen of the Oesophagus to the skin. 



The anatomy for the operation of removal of the Thyreoid Gland is similar 

 (cf. Fig. 67). 



At the bifurcation of the Common Carotid Arter)- lies the Carotid Body, 

 composed of a delicate plexus of blood vessels and sympathetic nervous tissue. 



Its functions are not known. 



