122 APPLIED ANATOMY. 



straight tongue depressor is used, Kirstein has shown that in many patients the 

 arytenoid cartilages and even a portion of the vocal cords can be seen. The open- 

 ing into the larynx can readily be felt by a finger introduced into the mouth. In cases 

 of suffocation from a foreign body, as a piece of meat, it is usually lodged at this 

 point, part of the foreign body being in the larynx and part in the pharynx. It can 

 readily be dislodged by the finger, as I have done in impaction of meat, the result of 

 vomiting in ether narcosis. The forefinger should be thrust its full length into the 

 mouth and throat and swept from side to side. The obstructing body can usually 

 be brushed aside and brought up in front of the finger into the mouth. 



The opening of the oesophagus is in a line with the long axis of the pharynx; it 

 is at its lower end. The opening of the larynx, on the contrary, is more on its 

 anterior wall. It is for this reason that when an cesophageal tube is introduced, either 

 through the mouth or through the nose, it goes down into the oesophagus and does 

 not enter the larynx. The oesophagus is narrowest at this point. 



The pharyngeal tonsil stretches across the posterior wall and roof of the 

 pharynx from the opening of one Eustachian tube to that of the other. It is also 



'Pharyngeal tonsil 



Fossa of Rosenmuller 

 Eustachian tube 



Supratonsillar tossa 



Pterygomandibular fold 

 Plica triangularis 



'Anterior pillar 

 Faucial tonsil 

 Posterior pillar 



Epiglottis 



FIG. 155. Lateral view of the pharyngeal region. 



known as Luschkrf s tonsil. It is composed of lymphoid tissue, and when enlarged 

 constitutes the disease known as adenoids. It is not true secreting gland tissue, 

 though it contains some mucous glands. It hangs from the vault of the pharynx in a 

 more or less lobulated mass and when large, in children, obstructs nasal respira- 

 tion. Mouth-breathing results, the child is apt to snore and make queer sounds 

 when sleeping, and the habit of keeping the mouth open causes a peculiar expres- 

 sion of the face almost pathognomonic of the affection. The blood supply at times 

 is abundant. When adenoids are present, their removal is usually undertaken. 

 This is done by introducing an instrument either through the nose or through the 

 mouth and scraping them off. A curette is used for this purpose. That known as 

 Gottstein's consists of an oval-shaped ring set at right angles to a long shaft. It is 

 introduced through the mouth and up behind the soft palate. It is then pushed 

 against the vault of the pharynx and posterior wall and drawn downward cutting 

 and scraping the adenoid tissue away. A much smaller ring curette set on a long, 

 delicate, but stiff handle may be used through the nose for the same purpose. In using 

 the latter instrument, it is common to use an anaesthetic and operate with the head 

 in a hanging position. Free bleeding may occur from this operation. To control it, 

 injections of ice water or a strong alum solution may be tried or gauze may be 

 packed behind the soft palate or pushed in from the anterior nares. A folded pad of 



