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Show 260 TO FIND 'rnn wocnnnn ARTERY BY DISSECTION. or woannzn ARTERIES. If vessels bleed in making this incision, they are muscular branches of the thyroid artery. fill‘llltiitL (LARO'I'ID ARTERY. I HAVE not in this place to speak of the propriety of taking up this artery. I describe the exact situation of it, first to shew the possibility of putting a ligature round it; and in the second place to give such an accurate description of its place, as may enable the surgeon to avoid. Cut through the skin from the lobe of the ear towards the point of the os hyoides : dissect through the platisma myoides ; we then come to the digastric muscle, we dissect a little along its upper edge and there we find the stylo hyoideus; forcing this last muscle a little downward we find. the continued trunk of the external carotid artery. _ . "v.4," ,..... ~ "n. '.-,.- .- r TO CUT FOR THE OF THE THYROID ARTERIESa Tun inferior thyroid lies in a situation not to be tied. It 261 artery rising in two branches, to be distributed to the gland. It would appear that these branches were descending from the carotid, by the acute turn they take downwards from their highest point on the neck. I hope none of my young friends will ever enter on the extirpation of the thyroid gland from any thing I have said here. TO FIND THE LINGUAL ARTERY- THE lingual artery makes its great curve (being tortuous) immediately above the great horn of the os hyoides; it then passes under the mylo-hyoideus. Were it ever necessary to out upon it here, let the extreme point of the os hyoides be the mark; for it turns just above it to pass under the mylohyoideus. Cut through the platisma myoides, raise the low- er edge of the sub-maxillary gland. Take care of the nerve which you see lying near it: it is the ninth pair, and is betwixt the artery and the tendon of the digastrical or biventer maxillaa. f..w«"lu7- -www~,.p+-. ‘a fig lies near the side of the vertebrm, where it is, on the outer side of the carotid artery, fully five fingers' breadth from the clavicle. It. might be sought for directly under the emobyoideus, and betwixt the carotid and the anterior edge of the scalcni. But in the living body it cannot be taken up there. In cutting for it, I cut the sympathetic and the phrenic nerve. It would be better to endeavour to reach the ramus thyroidius, by turning over the side of the gland which lies before the carotid trunk. By thus stretching the gland, we find the artery as if descending from above, in two branches, to the lower part of the gland. It may be proposed, previous to the attempt of extirpating the thyroid gland, to tie the four arteries which supply it. We cannot reach the inferior thyroid artery before it has passed under the carotid: the only possible way is, as I have just said, to lift up the inferior lobe of the tumour, separating the carotid from it; when we. find the inferior thyroid OF THE EXACT PLACE OF THE OCCIPITAL ARTERY. Tun occipital artery is found immediately under the mastoid process; from under the insertion of the mastoid muscle it runs backwards, on a level with the tip of the ear, under the insertion of the trapezius, and, of course, under the superior transverse ridge of the occipital bone. On the side of the neck, the internal jugular vein is immediately under it 7, it is under the origin of the digastricus. TO FIND THE SUBCLAVIAN ARTERY. THE patient is seated ; and the assistant at his back, with his fingers in the cavity behind the clavicle, pushes forward and downward to compress the artery. ‘ ‘ . :2 t,‘ " ‘ ."fimh‘f'l: 1‘ VIUNI M999 ' |