70 LIGATION OF THE CAROTID ARTERY 



18. LIGATION or THE CAROTID ARTERY 

 Fig. 25, 26 



Objects. The control of hemorrhage from wounds or the 

 prevention of hemorrhage during the removal of tumors or 

 other operations in the parotid region. 



Instruments. Scissors, scalpel, tenacula, aneurism needle, 

 mouse-toothed forceps, ligation forceps, suture material. 



Technic. The operation is possible on the standing animal 

 with the aid of cocaine or other local anaesthetic but it is 

 preferable to confine the patient in laternal recumbency and 

 anaesthetize. 



The operation is made at the same point as for phlebo- 

 tomy and the same cutaneous wound, a. Fig. 25, may be 

 used for this purpose. The incision should be at least 10 

 cm. long, extending through the skin, fleshly panniculus 

 and subscapulo-hyoideus muscles and then a passage forced 

 with the fingers to the trachea. At the region of the neck 

 indicated, the carotid passes along the border between the 

 lateral and dorsal surfaces of the trachea, accompanied dor- 

 sally by the vagus and sympathetic nerves and ventrally by 

 the recurrent. (In Fig. 25, the vagus and. sympathetic 

 nerves, v and s, are pushed out of their normal position and 

 appear ventrally to the carotid.) Pass the index finger 

 over and behind the carotid until the trachea is reached, 

 and encircling the inner and lower sides of the artery, 

 force a way through the surrounding areolar tissue and 

 draw the vessel out through the wound. As a rule the 

 carotid is still loosely surrounded by connective tissue, which 

 comes from the deep fascia of the neck and in which also 

 the three above-mentioned nerves are found. These nerves 

 must be carefully separated from the carotid and must on 

 no account be included in the ligature. If it is desired to 

 permanently destroy the vessel, ligate the carotid twice with 

 an interval of about 2 cm. between the two ligatures and 



