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Arteries Of The Neck. - Ligation.

Part 3
The External Carotid Artery

Of recent years the externalcarotid arteryhas been ligated far more often than formerly, as it was customary to ligate the commoncarotidinstead. Theexternalcarotid runs from the upper border of thethyroid cartilageto theneckof the mandible. It supplies the outside of the head,face, and neck. These parts are the seat of variousoperationsfortumors, especiallycarcinomaof themouthandtongue, diseased lymph-nodes, and other affections, and the external carotid and its branches are not infrequently ligated in order tocut offtheirbloodsupply.

Fig. 173. -Ligationof externalcarotid arteryand its branches.

In extirpation of the Gasserianganglion,hemorrhagehas been such an annoying and dangerous factor that a preliminaryligationor compression (Crile) of the external carotid is frequently resorted to. Thisarterymay also be ligated forwounds, resection of theupper jaw, hemorrhage from the tonsils, and angiomatous growths affecting theregionwhich it supplies.

Unlike some otherarteriesthe external carotid sometimes seems to have no trunk, consisting almost entirely of branches. Therefore in ligating it one should not expect to find a bigarterythesizeof the internal carotid, but oftenone onlyhalf as large. The branches of the externalcarotid arteryare the superior thyroid, lingual, and facial, which proceed anteriorly toward the medianline; the occipital andposteriorauricular, which supply the posterior parts; the ascending pharyngeal, which comes off from its deep surface and ascends to the base of theskull; and the temporal and internal maxillary arteries, which are terminal. It is ligated either near its commencement just above the superior thyroidarteryor behind the angle of the jaw above the digastricmuscle.

Ligation Of The External Carotid Artery Above The Superior Thyroid

At its commencement at the upper border of the thyroidcartilagethearteryis quitesuperficial, being covered by theskin, superficial fascia, platysma,deep fascia, and overlying edge of the sternomastoid muscle. It is to be reached through an incision 5 cm. in length along theanterioredge of the sternomastoid muscle in a line from thesternoclavicular jointto midway between the angle of the jaw and themastoid process. The middle of the incision is to be opposite the thyrohyoid membrane. The bifurcation of the commoncarotid arteryis an important landmark.

The superior thyroidarteryis given off at the very commencement and sometimes even comes from the common carotid just below. The ascending pharyngeal is the next branch, about 1 cm. above the superior thyroid. It comes off from the deep surface of theartery; almost opposite to it and in front is the lingual. It will thus be seen that the distance between the lingual and the superior thyroid, where the ligature is to be placed, is quite small. The superior thyroid is about opposite the upper border of the thyroidcartilage, while the lingual is opposite the hyoid bone. Beneath thearteryis the superior laryngeal nerve, but it is not liable to be caught up by the needle in passing the ligature because it lies flat on the constrictors of thepharynxand is apt to be a little above the site ofligation.

Theveinsare the onlystructuresliable to cause trouble. They are superficial to the arteries. On account of their irregularity more may be encountered than is expected. The superior thyroid and lingual veins both cross thearteryto empty into the internal jugular. The facial vein is also liable to be met, as the facialarteryfrequently springs from a common trunk with the lingual. The communicating branch between the facial andexternal jugular veinis another one that should be anticipated. These veins, when it is possible, are to be hooked aside; otherwise they are to be ligated and cut. Great care should be taken not to mistake a vein for theartery. It might appear an easy matter to readily recognize thearteryand distinguish between it and the veins, but this is not always the case in the living subject. The veins may have some pulsation transmitted to them from the adjacent arteries and thearterymay temporarily have its pulsations stopped by pressure from the retractors. The livingarterytouched by thefingerseems soft and does not give the hard, resisting impression felt in palpating the radial in feeling the pulse. The difference in thickness of the coats is also sometimes not apparent at a first glance.

The ligature is to be passed from without inward so as to guard against wounding the internal carotid.

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