File:The principles and practice of surgery (1916) (14577560849).jpg

Identifier: principlespracti1916warr (find matches)
Title: The principles and practice of surgery
Year: 1916 (1910s)
Authors: Warren, Richard, 1876-
Subjects: Surgery Surgery
Publisher: Philadelphia : Lea & Febiger
Contributing Library: Columbia University Libraries
Digitizing Sponsor: Open Knowledge Commons

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cricothyroidartery and the vocal cords. Thelaryngotomy tube (which is oval in section and is curved in the direction ofits least diameter) is passed, the lower pharynx packed, and anaesthesiaadministered through this tube. This has the advantage of taking lesstime than tracheotomy and that when all danger of bleeding has ceasedthe tube is removed and the wound rapidly heals. The operation is onlyavailable in adults, as in children the cricothyroid space is too small, andin these patients a high tracheotomy, which often encroaches on thecricothyroid space, takes its place. Tracheotomy, or opening the Irachea below the Larynx. Thisoperation is usually done above the isthmus of the thyroid gland (hightracheotomy), sometimes cutting through the cricoid (cricotracheotomy), lessoften below or at the isthmus after dividing the latter (low tracheotomy).Anatomy. The trachea is normally in the middle line (it may be pushedover by growths). In front are the sternohyoid and sternothyroid muscles
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Fig. 1(51. Operations on the air-passages.a. Subhyoid pharyngotomy. b, Laryngo-tomy. c, High tracheotomy. d, Lowtracheotomy. (Note the inferior thyroidveins.) HIGH TRACHEOTOMY 475 and the isthmus of the thyroid gland, which lies in front of the third, fourth,and fifth rings. The innominate artery and vein are important relationsof the thoracic part. (a) The High Operation. Indications, (a) In acute laryngeal obstruc-tion due to impacted foreign bodies ; (b) scalds of the upper larynx inchildren ; (c) diphtheria ; (d) acute oedema of the larynx from simplelaryngitis, syphilis, perichondritis, cancer, more rarely renal disease andtubercle ; (e) for spasm of the cords in tetanus or double abductor paralysis ;(f) for chronic stenosis of the larynx from syphilis. Tracheotomy should not be too long delayed, especially when done inchildren for diphtherial laryngitis, or the patients chances may be diminished,nor should one wait till the latter is in extremis with respiratory and cardiacfailu

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