Fig. 68. Outer Region of the Neck. Upper Cervical Ganglia of 



Sympathetic. 



The head of a male, aged /o, is turned to the I'ight, and drawn backwards. 

 A large window has been made in the skin, the Platysma and External Jugular 

 Vein have been removed, the Sterno-Cleido- Mastoid Muscle and Internal Jugular 

 Vein drawn forwards, and the Trapezius pulled backwards. The Thoracic 

 Duct is white, the Sympathetic Chain and, its Ganglia are or ange (by mistake, 

 the Spinal Accessory Nerve has been drawn superficial to the Great Auricular 



Nerve: it should be the reverse). 



In Hg. 67, the parts are in their natural position; in this figure, the deeper 

 structures have been exposed by drawing the superficial muscles apart; the In- 

 ternal Jugular Vein, which really lies external to the Carotid Artery, has been 

 pulled inwards, the Sympathetic Chain begins with the Upper Cervical Ganglion 

 which is Vs^h inch, long, and 0.3 inch, broad ; its upper end lies opposite the trans- 

 verse process of the 2nd or 3rd Cervical Vertebra; its lower end, opposite the 4th, 

 5th or 6th Cervical Vertebra. At its lower end is seen the sympathetic chain 

 which goes to the Inferior Cervical Ganglion (cf. Fig. 70). This Ganglion varies 

 in size and may form one mass with the ist Dorsal Ganglion, it lies on the head 

 of the I St rib at its point of articulation with the body of the ist Dorsal Vertebra. 

 The sympathetic chain frequently forms a loop around the Subclavian Artery 

 (Ansa of ViEUSSENS). Between the Upper and Lower Cervical Ganglia Ues the 

 middle Cervical Ganglion in front of the Inferior Thyreoid Artery, which may 

 also be surrounded by a loop of S3'mpathetic fibres. The Sympathetic Chain lies 

 behind the Carotid Artery, and is fixed to the Vertebral Column and the Pre- 

 vertebral Muscles. It therefore does not move with the Carotid Sheath, in the 

 same way as the Vagus. When ligaturing the Carotid Artery, there is no need 

 to trouble about the Sympathetic but one has to take care not to include the 

 Vagus in the ligature with the Artery. 



The Sympathetic is, therefore, in a well protected position, and rarely 

 damaged in accidents, or during operations (removal of tumours). In recent years, 

 the Sympathetic has been divided and more or less removed (Superior Cervical 

 Ganglion etc.) for Epilepsy, Glaucoma and Gr^WE's disease. The Sympathetic 

 can be exposed by a longitudinal incision along the anterior border of the Sterno- 

 Mastoid Muscle; the Carotid Artery, Internal Jugular Vein and Vagus are drawn 

 aside. This proceeding is inconvenient, because the thin-waUed much distended 

 vein is held by the retractor. If one operated along the posterior border of the 

 Sterno-Mastoid drawing the muscle with the vein inwards, more room is obtained ; 

 if the incision has been continued downwards on to the clavicle, the lower Cervi- 

 cal Ganglion can also be removed, after having freed the clavicular head of the 

 Sterno-Mastoid from its attachment. The latter operation, however, is difficult, 

 because the Vertebral Vessels may lie up against the Ganglion near the Apex 

 of the Pleura (cf. Fig. 70). This should on no account be injured. 



This incision is the best for ligaturing the Vertebral Artery before it 

 enters the foramen in the transverse processes of the Cervical Vertebrae. 



