(2) The pretracheal fascia of the neck lies deep in the strap muscles
(sterno-thyroid, sternohyoid, and omohyoid) and partially encloses the thyroid gland,
trachea, and larynx. The pretracheal fascia is pierced by the thyroid vessels. It fuses
with the front of the carotid sheath on the deep surface of the sternocleido-mastoid.
The carotid sheath consists of a network of areolar tissue surrounding the carotid
arteries and vagus nerve.
(3) Laterally, the carotid sheath is fused with the fascia on the deep surface
of the sternocleidomastoideus; anteriorly, it is fused with the middle cervical fascia along
the lateral border of the sternothyroideus muscle. Lying between the floor and roof of
this triangular formation of muscles are the lymph glands and the accessory nerve.
Arteries and nerves traverse and pierce this triangle.
h. Lymphatic System of the Neck. The lymph glands of the neck are closely
associated with the salivary glands and the lymph plexus. The submaxillary nodes,
located in the submaxillary triangle, drain the cheek, side of the nose, upper lip, side of
the lower lip, gums, side of the tongue, and medial palpebral commissure. Lymph from
the facial and submental nodes also drains to these glands. The superficial cervical
nodes, following the external jugular vein, drain the ear and parotid area to the superior
deep cervical nodes. The cervical nodes are in close contact with the larynx, thyroid
gland, nasal cavities, ear, nasopharynx, palate, esophagus, and skin and muscles of the
1-34. PREP, POSITION, DRAPE, AND ANESTHESIA
a. The face is prepped with an antibacterial detergent, as for surgery of the
nose. The inside of the mouth is not prepped. When the approach is through the lower
throat, the area from the jaw line to the upper clavicle is prepped.
b. The supine position is usually employed during surgery of the throat. If a
local anesthetic is used for an adult tonsillectomy, the patient is placed in a sitting
c. The patient's head is covered with sterile towels and he is draped with a sheet
as for nasal surgery.
d. For surgical procedures other than an adult tonsillectomy, a general
anesthetic may be used. A local anesthetic is given to the adult for tonsil surgery unless
that patient is allergic to the drug. To administer the local anesthetic, special tonsil
needles are used. They are longer than the normal needles used for local infiltration
and have a ridge which prevents their being inserted too deeply.
a. General. This procedure is a mode of direct visual examination of the interior
of the larynx by means of an electric-lighted speculum known as a laryngoscope, in