A Manual of the Operations of Surgery, page 198 by Joseph Bell
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ree different situations, and to the operations at these different places the following names have been given:--
Laryngotomy, when the opening is made in the interval between the cricoid and thyroid cartilages, through the crico-thyroid membrane.
Laryngo-tracheotomy, when the cricoid cartilage and the upper ring of the trachea are divided.
Tracheotomy, when the trachea itself is opened by the division of two, three, or more rings.
Of these the last, tracheotomy, is by far the most frequent, important, difficult, and dangerous, and requires a very detailed description. Chassaignac[127] says "the only really rational operation for the opening of the air passages by the surgeon is tracheotomy."
TRACHEOTOMY.--Anatomy.--Between the cricoid cartilage and the level of the upper border of the sternum, the middle line of the neck is occupied by the upper portion of the trachea. Its depth from the surface varies, gradually increasing as the trachea descends, and varying very much according to the fatness, muscularity, and length of the neck. It is, however, almost subcutaneous at the commencement below the cricoid, and on the level of the sternum it is in most cases at least an inch from the surface, in many much deeper. Again, its length varies, even in the adult, from two and a half to three, or even four inches. This is important, as affecting the simplicity of the operation, which, as a rule, is easier the longer the neck is.
The trachea has most important and complicated anatomical relations--some constant, others irregular.
1. The carotid arteries and jugular veins lie at either side, but, where these are regular in their distribution, do not practically interfere in a well-conducted operation.
2. The thyroid gland lies in close relation to the trachea, one lobe being at each side (Fig. XXXI. B B), and the isthmus of the thyroid crosses the trachea just over the second and third cartilaginous rings. In fat vascular ne