John Simon

“ When the hyoid bone is fixed by its depressors (and perhaps in some degree retracted by the joint actions of the posterior belly of the digastric and of the omo-hyoid) , the anterior belly, both passively as a reflected cord, and actively, in virtue of its muscular fibres, depresses the lower jaw and opens the mouth. Simultaneously, too, with its act of raising the pharynx, this muscle must tighten, by its posterior belly, the mesial aponeurotic expansion, which joins it to its fellow; and, by so doing, must assist the mylo-hyoid in raising the floor and reducing the capacity of the mouth. ”

“ A small artery sometimes forms, with its fellow of the opposite side, a transverse communication across this membrane, and its presence has been much insisted on as a circumstance of practical importance: it is of extreme minuteness, and by no means constantly present: it is the crico-thyroid, and arises from the thyroid branch of the external carotid, near the upper angle of the thyroid body, and runs across the membrane toward the median line. ”

“ The sterno-cleido-mastoideus is a long and powerful muscle, obliquely crossing the side of the neck, from the neighbourhood of the sterno-clavicular joint to the mastoid process of the temporal bone. It is fleshy in almost its whole extent; flattened at the extremities, but rather prismatic in the intermediate portion; and the anterior edge, which is more particularly continuous with the sternal origin of the muscle, and which, in certain positions of the neck, raises the integuments in a well-known diagonal relief, considerably exceeds the thickness of the posterior border. ”

“ The sterno-hyoid and sterno-thyroid are two riband-like muscles, having respectively the attachments denoted by their names,—situated beside the median line, so as to be divided from their fellows on the opposite side only by the mesial raphe of the cervical fascia,—covering the trachea, thyroid body, with a portion of the larynx, and overlapping the sheath of the carotid vessels. They are isolated from each other, and from the other muscles of their neighbourhood, by processes of the cervical aponeurosis. ”

“ Should the carotid have been tied, its mesial communications, already mentioned, especially those within the skull, and about the thyroid gland,—assisted at those places and elsewhere by anastomoses with the subclavian,—adequately fulfil their vicarious duty. So abundant are these various communications, that the ligature of a main trunk, in the dead subject, in no degree interferes with the distension of its branches by fine injection: if we inject water, or any equally fluid material, through one carotid artery, it freely returns by the other. ”

“ Those already considered operate on the tongue en masse;—elevate, advance, depress or retract it, shift its volume to either side, and direct its extremity, by a kind of circumduction, over a wide range of surface. Thus, the stylo-glossus can elevate and retract, the hyo-glossus depress and lateralise; the anterior fibres of the genio-hyo-glossi, with the linguales, regulate the motions of the tip, while the genio-hyoid and adjunct fibres of the genio-hyo-glossi can cooperate in these movements by shifting the base of support in any direction. ”

“ The thyro-hyoid muscle covers the superior laryngeal nerve and artery as they pierce the wall of the larynx. These muscles are fleshy in their whole extent, with exception of the short tendinous fibres, by which they have their origin and insertion: the sterno-thyroid has frequently a transverse tendinous intersection in some part of its course. ”

“ The anterior fibres are short; those which succeed progressively increase in length, and the posterior, which are fixed to the hyoid bone, are of all the longest. Each muscle is, therefore, triangular, having an outer edge by which it rises from the jaw, an inner edge of union with its fellow, and a posterior edge, which is seen to extend, in the digastric space, from the posterior extremity of the myloid ridge to the upper edge of the body of the hyoid bone, close to its cornu. The under surface of the muscle corresponds to the submaxillary gland and to the insertion of the digastric ”

“ Attempts at suicide by cutting the throat seldom succeed; the incision is usually made closely either above or below the hyoid bone; in the former case entering the digastric regions, and dividing, with the muscles of the tongue, the lingual and perhaps the facial artery; in the latter case, traversing the thyro-hyoid membrane, penetrating the pharynx, perhaps implicating the epiglottis, dividing the thyroid artery, and very rarely reaching the external carotid. ”

“ Certain veins in the neck have an anatomical disposition, rendering them liable, when opened in surgical operations, to become channels for inspiration of air to the cavities of the heart, the fatal tendency of which is well known. ”

“ The necessity for haste is commonly of too urgent a character to admit of any deliberate, layer-by-layer, dissective operation: a single steady puncture with a canulated trocar, or with a bistoury—directly followed by a tube—is the usual mode of conducting it. ”

“ This point is in young subjects the highest level to which the aorta attains; but, as Cruveilhier notices, in old age the extreme part of the arch, which corresponds to the origin of the left subclavian artery, is higher. In early life, too, from incomplete development of the sternum, the convexity of the arch more nearly approaches the root of the neck than in adult growth, and, as also the branches arising from it, may more easily be endangered in tracheotomy and other operations in the neighbourhood. ”

“ It seems to have been considered, in operating for aneurism, that, so long as no large branch arose from the vessel closely on the cardiac side of the ligature, it mattered not what branches might arise on its distal side,—how large, or how near. In many instances secondary hæmorrhage, inducing death, has manifestly depended on defective adhesion at the distal side of the ligature, and for an obvious reason. The condition of that part of the artery has been neglected: it has been thought unimportant though a large vessel should arise just beyond the ligature ”

“ This little region can hardly be said to have any special surgical relations; it contains neither vessels nor nerves of size; its injuries only assume importance when they extend beyond it into the adjoining digastric space; its diseases derive no peculiarities from their situation, and for the most part belong to the integuments, which are vascular, highly folliculated, and in the male densely bearded: sycosis often extends to them, and they are a frequent seat of sebaceous tumours. ”

“ On the left side, the œsophagus, inclining from the median line, presents itself in the antero-inferior triangle. It only half emerges from behind the trachea (which still covers its right portion) , and closely lies on the vertebræ: it continues the canal of the pharynx, from a line of abrupt distinction opposite the lower edge of the cricoid cartilage, downward. It is at its commencement that this tube most frequently interests the surgeon, by becoming the seat of stricture, or by arresting and fixing foreign bodies. To this space the operation of œsophagotomy belongs ”

“ Sharp instruments penetrating downward beside the tongue may wound the sublingual artery, and the consequent hæmorrhage, distending the submucous space, raise the reflected membrane on each side into swellings of such size, as to suggest imminent peril of suffocation. ”

“ The lymphatic glands are numerous and important: they receive the absorbent vessels from the face and likewise from the mouth and pharynx, are the frequent seat of strumous inflammation, readily sympathize in disordered conditions of the fauces and alveoli, and take an active part in propagating the malignant influence of cancerous ulcerations on the face. ”

“ Although the arteria innominata cannot in anatomical strictness be considered as belonging to the neck, yet, in regard both of disease and of surgical operation, its affinity to that region is so close as to warrant its mention in this place. It rises from the convexity of the arch of the aorta, just as that main vessel, having terminated its ascent, inclines leftward. ”

“ The thyroid cartilage is sometimes partially divided in attempts at self-destruction, which it commonly frustrates by defending more important parts. 3. A depression which answers to the crico-thyroid ligament: it is here that the usual operation for urgent glottic dyspnœa is performed. The common integuments and the fascial raphe cover the little interspace in question, which is safely reached—between the crico-thyroidei—by displacing in a slight extent the sub-hyoid muscles. ”

“ The gento-hyo-glossus is a large, fan-shaped muscle, radiating from within the symphysis of the jaw to the entire length of the tongue, and constituting, with its fellow, the chief muscular bulk of that fleshy organ. It rises by a strong square mass of short tendinous fibres from the upper genial tubercle, and the fleshy fibres, which succeed, immediately and widely diverge ”