THE MOUTH AND THROAT. 



in 



is drawn out of the way and there will be only slight bleeding from small branches 

 of the sublingual, which comes from the main trunk at the anterior edge of the hyo- 

 glossus muscle. From this point forward to the tip, the lingual artery is called the 

 ranine. The tongue having been loosened and pulled out, Mr. Jacobson makes a 

 transverse cut through the mucous membrane behind the growth and then, by push- 

 ing the tissues aside with a blunt instrument, exposes the lingual nerve and artery 

 lying together beneath the mucous membrane. The artery is then tied and the 

 growth removed. 



In order to secure any bleeding points after the tongue has been cut away, the 

 floor of the mouth can be raised and pushed forward by the fingers beneath the chin. 



Styloglossus muscle 

 Hyoglossus muscle 



Hypoglossal 

 nerve 



Lingual nerve 



Submaxillary 

 ganglion 



Lingual nerve 



Geniohyoglossus muscle 

 Ranine artery 



Ranine vein 

 Sublingual gland 



Submaxillary duct 



FIG. 138. The cheek has been split, the tongue drawri forward, and the mucous membrane removed from 

 its under surface, exposing the ranine artery and vein, the lingual and hypoglossal nerves, the sublingual gland, 

 the Submaxillary ganglion, and the duct of the submaxillary gland. 



This brings the stump into view and within reach. If lymphatic nodes are to be 

 removed, they must be sought for by an additional incision on the outside beneath 

 the jaw. 



The roof of the mouth is formed by the hard palate and the soft palate ; the 

 former comprising about three-fourths and the latter one-fourth. The hard or bony 

 palate is composed in its anterior two-thirds of the palatal processes of the superior 

 maxillary bones, and in its posterior third of the palatal bones. In the median line 

 close to the incisor tooth, in the dried skull, is the anterior or nasopalatine foramen. 

 This is subdivided into four foramina, two lateral and two anteroposterior. The 

 former, called the foramina of Stenson, transmit the terminal branches of the de- 

 scending palatine arteries; of the latter, called \\-\eforaminaofScarpa, the anterior one 

 transmits the left nasopalatine nerve, and the posterior one the right nasopalatine 

 nerve. The soft tissues of the roof of the mouth are thicker than they appear to be, 

 so that when they are raised, as in operating for cleft palate, they form quite a thick 

 layer. Infection of the roof of the mouth when it occurs is usually by extension from 

 neighboring diseased teeth, abscesses being sometimes produced. 



The blood supply of the roof is of importance in relation to the operation for cleft 

 palate {staphylorrhaphy} (Fig. 139). The blood comes anteriorly from the nasopala- 

 tine arteries and posteriorly from the descending palatine arteries, which come down 



