1596 HUMAN ANATOMY. 



the epiglottis. Often this does not suffice, and direct traction on the tongue itself 

 is required. 



Excision of the entire tongue necessitates division of the muscles of the tongue, 

 its connections by mucous membrane with the soft palate, the alveoli, and the 

 epiglottis, the lingual arteries and veins, and the glosso-pharyngeal, lingual, and 

 hypoglossal nerves. 



In opening abscesses of the tongue the position of the lingual arteries — much 

 nearer the lower than the upper surface — should be remembered. 



Hemorrhage from wounds or during operation may temporarily be controlled by 

 pressure from behind forward on the base of the tongue by two fingers thrust well 

 below and behind it in the pharynx. By this procedure, or by forcing up the soft 

 tissues between the inferior maxilla and the hyoid bone with the finger or thumb, 

 the cut surface during partial excision may be brought well into view and the 

 hemorrhage controlled while the vessels are sought and secured. 



THE PHARYNX. 



The pharynx is a bag, open in front, with musculo-membranous walls, lined with 

 mucous membrane, extending from the base of the skull to the lower border of the 

 larynx, near the level of the top of the seventh cervical vertebra. Thus it is bounded 

 behind by the spine, covered by the prevertebral muscles and fascia, and by the basilar 

 process of the occipital bone, which, especially in the median line, is separated by 

 much areolar tissue, as well as by muscles from the posterior wall. The steep rise 

 of the basilar process, together with the downward growth of the face, forms the 

 deep recess known as the naso-pharynx. The roof is formed by a little of the front 

 of the basilar process and by the back part of the basi-sphenoid. The anterior wall is 

 formed by the back of the framework of the face, the soft palate, the back of the 

 tongue, the hyoid bone, and the larynx. The pharynx communicates in front with 

 the nasal chambers and the mouth ; the Eustachian tubes open into it on either side 

 near the top ; and below it contains the opening of the larynx, behind which it passes 

 into the oesophagus. The framework consists of the pharyngeal aponezirosis, a dis- 

 tinct fibrous membrane above, placed between the mucous membrane and the mus- 

 cular layer, which grows weaker below and is continued into the gullet. This is 

 attached above to the pharyngeal tubercle and to the occipital bone on either side 

 of it, to the cartilage between the petrous portion of the temporal and the basilar 

 process, to the Eustachian tube which passes over it, and to the base of the internal 

 pterygoid plate. This fascia is wanting in front. The parts forming most of the 

 anterior wall — the soft palate and the back of the tongue — are capable of changing 

 their relations. The pharynx is enclosed by a layer of fascia, the bncco-pharyngeal 

 (not to be confounded with the pharyngeal aponeurosis), the front part of which is 

 connected with the pterygo-mandibular ligament and covers the buccinator muscle. 

 This fascia lies beneath the parotid gland and mingles with the cobweb-like tissue of 

 the carotid sheath to make a large amount of rather dense areolar tissue on either side. 

 At the back it is very lax, allowing the pharynx to move on the smooth prevertebral 

 fascia. The condition there approaches that of a serous bursa. 



The pharynx is divided into the naso-, oro-, and laryjigo-pharynx by folds on 

 the anterior and lateral walls. The uninterrupted posterior wall is covered with 

 smooth mucous membrane, which, behind the larynx, tends to be puckered into 

 longitudinal folds. The naso-pharynx is that part above the free edge of the soft 

 palate. The oro-pharynx communicates at the anterior pillar of the fauces with the 

 mouth. The isthmus, a niche between the faucial pillars containing the tonsils, is its 

 anterior part. It is separated from the laryngo-pharynx by the pharyngo-epiglottic 

 fold, which extends from the epiglottis to the side of the pharynx, as more particu- 

 larly described later. The length of the male pharynx is about 13 cm. (about 5 in.), 

 which is rarely much exceeded. The greatest breadth (4-5 cm.) is near the top of 

 the laryngo-pharynx, rather below the greater horns of the hvoid bone. The greatest 

 breadth in the naso-pharvnx, between the deepest points of the fossa of Rosenmiiller, 

 is 3.5 cm., or perhaps a little more. Behind the upper margin of the cricoid cartilage 

 the breadth is not over 3 cm., below which it abruptly diminishes. The antero- 



