582 



NECK. 



a partial septum, divides a superficial space 

 from the general submucous tract; and it is 

 necessary to understand this arrangement, in 

 order to apprehend the mode in which the sub- 

 maxillary gland approaches the mucous mem- 

 brane of the mouth : the gland lies in the su- 

 perficial division of the space, and it is round 

 the posterior edge of the mylo-hyoid muscle 

 that its duct is reflected in proceeding to dis- 

 charge itself, which by so entering the sublin- 

 gual space it is enabled to do. The anterior 

 division of the digastric space contains, super- 

 ficially the giand just mentioned, the facial 

 artery and vein with some of their branches, 

 the mylo-hyoid twig from the third division of 

 the fifth, and many lymphatic ganglia. The 

 gland receives a thin capsular investment from 

 the deep surface of the fascia, closing the space, 

 and this prolongation contracts and condenses 

 itself round the posterior extremity and duct, 

 accompanying these in their turn round the 

 mylo-hyoid, and furnishing the duct with a 

 dense fibrous tunic. The artery enters the 

 space from below, by passing beneath the pos- 

 terior belly of the digastric muscle, very tor- 

 tuously winds through the submaxillary gland, 

 and bends over the basial edge of the jaw a 

 little in front of the masseter. It furnishes a 

 deep ascending branch (the tonsillary) near the 

 angle of the jaw and many glandular twigs ; 

 but its only considerable branch in this region 

 is the sub-mental, which runs toward the me- 

 dian line just beneath the jaw, and, supplying 

 the mylo-hyoid muscle on which it is applied, 

 and the anterior belly of the digastric, termi- 

 nates bv freely communicating with its fellow. 

 The sub-mental branch derives additional im- 

 portance from the frequency of an anomalous 

 distribution, by which, piercing the mylo-hyoid 

 muscle and entering the sublingual space, it 

 partly discharges the functions of the lingual 

 artery in supplying the sublingual gland. The 

 facial vein lies behind the artery, and quits the 

 space below in passing over the digastric and 

 stylo-hyoid muscles, which divide it from the 

 artery. Its usual or chief termination is in the 

 internal jugular ; but it frequently contributes 

 more or less to form the external or the ante- 

 rior jugular vein. The mylo-hyoid nerve runs 

 parallel to the origin of the muscle, which gives 

 it its name, and supplies it and the anterior 

 belly of the digastric. The lymphatic glands 

 are numerous and important: they receive the 

 absorbent vessels from the face and likewise 

 from the mouth and pharynx, are the frequent 

 seat of strumous inflammation, readily sympa- 

 thize in disordered conditions of the fauces and 

 alveoli, and take an active part in propagating 

 the malignant influence of cancerous ulcerations 

 on the face. These parts are all covered in by 

 the aponeurosis, which fixes itself to the base 

 of the jaw, and by the platysma and superficial 

 fascia, which continue themselves on the face. 

 They are readily accessible to the surgeon, but 

 seldom subjected to any operation of impor- 

 tance. The deep or sublingual portion of the 

 digastric space has its roof formed by the mu- 

 rous membrane, which, between the tongue and 

 alveolar arch, constitutes the floor of the mouth: 



the side of the tongue and the continuous sur- 

 face of the pharynx, as already described, com- 

 pose its inner wall ; and it follows from the 

 previous description that, in part at least, the 

 mylo-hyoid is its floor. The gustatory nerve 

 runs through it beneath the mucous membrane, 

 which it supplies : the hypo-glossal, describing 

 a parallel but inferior curve, is distributed in 

 succession to the muscles of the inner wall of 

 the space ; the glosso-pharyngeal between these 

 two in height, but confined to the root of the 

 tongue, bends inwardly beneath the stylo- 

 glossus ; the lingual artery, emerging from 

 under cover of the hyo-glossus, which has 

 hidden its tortuous ascent, divides anteriorly 

 into two branches ; a ranine, which follows the 

 curved border of the tongue to its tip, where it 

 archingly unites with its fellow ; a sublingual, 

 which directing itself a little outward, supplies 

 the third salivary gland : this little body lies on 

 the divergent fibres of the genio-glossus, near 

 their origin, and close beneath the membrane of 

 the mouth : finally, the duct of the submaxillary 

 gland, traversing the space obliquely, crosses its 

 contents, and communicates with the cavity of 

 the mouth just beside the frcemim. This space 

 is the seat of ranula (a tumour formed by ob- 

 struction of the submaxillary duct), and of 

 some salivary concretions ; in both which com- 

 plaints the distended canal is brought so imme- 

 diately beneath the mucous membrane, which 

 it raises, that other parts are little liable to in- 

 jury : here, too, it is that the surgeon, when 

 obliged to divide the frcenum linguae, must 

 cautiously cut the too tight fold near to the 

 symphysis, and vertically, lest, in extending 

 his incision backward, he should wound the 

 ranine artery. Sharp instruments penetrating 

 downward beside the tongue may wound the 

 sublingual artery, and the consequent haemor- 

 rhage, distending the submucous space, raise 

 the reflected membrane on each side into swell- 

 ings of such size, as to suggest imminent peril 

 of suffocation.* 



7. The small region to which, under the 

 name of posterior pharyngeal, I propose giving 

 brief notice, has for its roof the basilar portion 

 of the occiput and petrous part of the temporal 

 bone, and presents in this direction the orifices 

 of the jugular, carotid, and anterior condylic 

 canals : it extends downwards between the pha- 

 rynx and vertebrae into the anterior triangle of 

 the neck, and is separated from the posterior 

 division of the digastric space, within which it 

 lies, by the styloid and vaginal processes, and 

 by the attachment to these of a strong layer of 

 fascia, which passes beneath the digastric mus- 

 cle. The internal carotid artery, surrounded by 

 branches from the superior cervical ganglion, 



* Such an accident I have seen arise from the 

 inadvertent thrust of a tobacco-pipe ; the swelling 

 was very considerable on both sides, and pro- 

 duced alarming distress. Cold (aided, no doubt, 

 by the pressure of the effused blood) succeeded in 

 staying the haemorrhage ; had this not been the 

 case, it would have been necessary to expose the 

 lingual artery on the cornu of the os hyoides and 

 to secure it ; or, had its ligature not sufficed, like- 

 wise to tie the adjoining trunk of the facial, from 

 which the sublingual branch is occasionally derived. 



