954 



PHARYNX. 



and that of taste see PAR VAGUM, SPINAL 

 ACCESSORY, GLOSSO-PHARYNGEAL.) The fur- 

 ther passage of the food through the oesophagus 

 into the stomach (see (ESOPHAGUS) constitutes 

 the third stage of deglutition and occurs invo- 

 luntarily. 



MORBID ANATOMY OF THE PHARYNX AND 

 MOUTH. 



Congenital malformations. The pharynx in 

 a very few instances only, presents any mal- 

 formation ; when such exists the pharynx ter- 

 minates in a cul-de-sac. Sir A. Cooper has 

 recorded a case of this kind, in which also the 

 oesophagus was altogether wanting and the 

 stomach without a cardiac orifice : the child 

 lived eight days. In acephalous monsters a 

 total deficiency of the pharynx has been no- 

 ticed, but this is of very rare occurrence. The 

 hard and soft palates are occasionally liable to 

 congenital fissure : owing to an arrest of de- 

 velopement they fail to unite in the median 

 line, and the result is what has been termed 

 the cleft palate: this defect maybe confined 

 to the velum palati, or it may include the bony 

 palate, and will sometimes extend through the 

 front of the jaw : where the bony palate is 

 involved the defect may vary from a mere fis- 

 sure to an entire absence of the palatine arch, 

 so that the nose and mouth are converted into 

 a common cavity. The upper lip is not un- 

 frequently fissured either on one or both sides 

 of the median line, constituting the single or 

 double hare-lip. This deformity may exist 

 with or without the fissured palate, but cannot 

 be considered as dependent simply on an arrest 

 of developement ; for at no period of fatal 

 life is the lip known to present this peculiar 

 condition : the fissure may only partially divide 

 the lip, or it may extend into the nose in an 

 oblique or vertical direction. It is very rare 

 to find the lower lip fissured. 



Foreign bodies in the pharynx may produce 

 immediate suffocation, either by mechanically 

 obstructing the opening of the larynx or by 

 inducing spasm of the glottis ; when any dif- 

 ficulty occurs in the extraction of these bodies, 

 it is more generally dependent on their form 

 than size. Angular portions of bone, needles, 

 &c. are likely to become fixed by the con- 

 traction of the pharyngeal walls upon their 

 pointed edges. 



Structural changes. The mucous mem- 

 brane of the pharynx and posterior part of the 

 fauces is very frequently the seat of inflam- 

 mation, either simple or of a specific cha- 

 racter ; thus, it rarely escapes in scarlatina and 

 syphilis without exhibiting the effects of these 

 poisons : the latter often producing, by ulce- 

 ration and sloughing, total destruction of the 

 soft or even of the hard palate and causing 

 fearful mischief. The tonsils generally parti- 

 cipate in these inflammatory affections, or they 

 may become inflamed primarily. In quinsy, 

 the swelling of the tonsil is excessively rapid, 

 and the disease is prone to terminate in sup- 

 puration. One effect of frequent inflammatory 

 attacks is an indolent enlargement of the tonsil, 

 a condition which is often with difficulty re- 



medied, and occasionally requires excision of 

 that organ. 



Abscess sometimes occurs in the reticular 

 tissue between the pharynx and cervical ver- 

 tebrae, and protrudes the posterior wall of the 

 former forwards, so as to interfere with de- 

 glutition. 



Ulceration of the pharynx occasionally hap- 

 pens; it may be the result of a simple or 

 specific inflammation, and will sometimes pro- 

 ceed to the destruction of its walls : fistulous 

 openings between it and the larynx or other 

 neighbouring parts may be thus produced. 

 Cancer of the pharynx is fortunately not com- 

 mon, but cases have been noticed in which it 

 has occurred. 



Polypi have sometimes been found to take 

 their growth from the mucous membrane of 

 the pharynx, and most commonly spring from 

 that portion of it which covers the posterior 

 aspect of the larynx. Dr. Monro mentions a 

 case of this kind in which the polypus was 

 of considerable length, hanging down in the 

 oesophagus ; another seat of origin in the 

 pharynx is from the membrane as it invests the 

 under surface of the basilar process of the 

 occipital bone : they have been seen to grow 

 also from the soft palate. 



A pouch is occasionally formed either be- 

 hind or on either side of the pharynx by an 

 extrusion through the muscular coat of its 

 mucous membrane. A preparation in the Mu- 

 seum at St. Thomas's Hospital exhibits such 

 an arrangement : a blind pouch about three 

 inches in length, and of course communicating 

 with the interior of the pharynx, descends by 

 the side of it : the muscular parietes do not 

 appear to have been at all prolonged upon its 

 surface. 



The cheeks, gums, and lips in children are 

 sometimes involved in a destructive ulceration, 

 to which the term cancrum oris has been ap- 

 plied ; it may extend to almost any length, 

 destroying the cheek, the lips, the gums, and 

 teeth : it is seldom seen in adults. The gums, 

 besides the softened and spongy change in- 

 duced by scurvy and the well known effect 

 caused by the introduction of mercury into the 

 system, are also affected with the disease called 

 epulis. In this case the gum is enlarged, 

 reddened, and ulcerates, and demands ex- 

 cision of the entire diseased structure : it is 

 generally considered of a malignant nature. 

 The lower lip is sometimes the seat of can- 

 cerous ulceration ; it has been questioned whe- 

 ther this disease is really true cancer. Sir A. 

 Cooper, however, says, in his lectures, " That 

 the disease is of a scirrhous nature, even at 

 the beginning, any surgeon must be satisfied ; 

 it is hard, has a bleeding surface, everted 

 edges, and, as it proceeds in its destructive 

 course, communicates disease to the glands : 

 there is likewise felt in it, at particular periods, 

 the most dreadful pain. An operation for the 

 complete removal of the disease is the patient's 

 only real hope of succour." It is very rare for 

 the same disease to originate in the upper lip. 



( William Trcw.) 



