Aneurysm of the right internal carotid. (Peacock.)
The Lingual Artery.
—The lingual artery may be conveniently tied before some of the radical operations on the tongue, and it is also tied in cases of cancer in order to shut off nutrition. Incision is made 2 Cm. above the hyoid, parallel with it, from the middle line nearly to the angle of the jaw. Through this the submaxillary gland will be exposed and should be retracted upward and out of the way. The fascia is then divided, and the posterior border of the mylohyoid identified. The digastric tendon is then drawn upward from the hyoglossus, upon which it rests. The hypoglossal nerve is now seen, the artery lying behind it. It is, therefore, necessary to divide the hyoglossus by a short incision in order to reach the vessel. The most important precaution is to avoid injury to the nerve ([Figs. 163] and [164]).
Fig. 163
Fig. 164
Surgical anatomy of the neck; ligation of the carotid, lingual, and facial arteries. (Bernard and Huette.)
Other Arteries of the Face and Head.
—The facial may be tied through an incision nearly identical with that for the external carotid, or at the margin of the lower jaw 1 to 2 Cm. in front of the angle. The temporal may be attacked through a vertical incision over its course between the tragus and the condyle. Branches of the facial nerve cross the artery at right angles to it; these should be avoided. The occipital may be tied close to its origin, through the same incision as that for the external carotid, or behind the mastoid, through an incision commencing at its tip, carried backward and upward. It will be necessary here to divide the posterior fibers of the sternomastoid, of the splenius, and perhaps of the trachelomastoid. The vessel is then recognized by its pulsation between the mastoid and the transverse portion of the atlas.