OPENING OF THE GUTTURAL POUCHES. 53 



II. OPERATIONS ON THE NECK. 



n. OPENING OF THE GUTTURAL POUCHES. 



PI.ATE X. 



Instruments. Razor, scissors, convex pointed and 

 straight probe pointed scalpels, artery forceps, tenacula 

 probe, trocar, curette, drainage tubing, suture and dressing 

 material. 



Technic. I. Viborg's method. The operation is possible 

 on the standing animal, but generally the patient must be 

 cast or placed on the operating table and secured in lateral 

 decubitis with the head extended. By extending the head 

 and compressing the jugular vein there is brought out the 

 triangle immediately behind the posterior border of the in- 

 ferior maxilla and below the parotid gland comprised be- 

 tween the posterior angle of the inferior maxilla, the terminal 

 tendon of the sterno-maxillaris muscle and the external 

 maxillary vein. In this so-called Viborg's triangle after the 

 removal of the hair and the disinfection of the skin which 

 is maintained stretched, make a 5 cm. long incision through 

 the skin and skin muscle immediately beneath the afore- 

 mentioned tendon and parallel to it. In case of pronounced 

 swelling in Viborg's triangle the operator must determine 

 the location for the incision by the position of the sterno- 

 maxillaris muscle. The skin and subcutem having been 

 incised to a sufficient extent, force a passage with the finger 

 or with probe pointed scissors closed or other blunt instru- 

 ment through the loose connective tissue on the median side 

 of the parotid gland, which area is free from large vessels 

 and nerves, to the guttural pouch and penetrate it at its 

 lowest point with the finger or trocar. In order to open 

 the empty guttural pouch it is desirable to grasp a portion 

 of its wall by means of forceps. Through the operative 



