THE MOUTH AND THROAT. 



123 



gauze may be attached to the thread of a Bellocq cannula and the pad introduced 

 as is done in plugging the posterior nares. A curved forceps with cutting blades 

 is also used to remove this growth. 



Fossa of Rosenmiiller. This is the depression above and behind the open- 

 ings of the Eustachian tubes. The walls of the pharynx are weakest at this point 

 owing to the superior constrictor muscle not coming so high up. Hernia of the 

 mucous membrane sometimes occurs here. When the beak of the Eustachian cath- 

 eter fails to enter the mouth of the tube it usually enters this fossa. 



The internal carotid artery runs up the neck outside of the pharynx and 

 opposite the space between the posterior arches of the palate and the posterior wall 

 of the pharynx. It is from i to 2 cm. behind and to the outer side of the tonsils. 

 It is separated from the cavity of the throat by its own proper sheath, by the thin 

 buccopharyngeal fascia covering the constrictor muscles, by the constrictor muscles, 

 the pharyngeal aponeurosis, and the mucous membrane. As the tonsils lie between 

 the pillars of the fauces, in opening a tonsillar abscess the knife is not carried either 



FIG. 156. Transverse dissection of the neck. The posterior wall of the pharynx has been removed and the vessels 

 exposed. The internal carotids are seen to be abnormally tortuous, with a tendency to bulge into the pharynx. 



behind or through the posterior pillar of the fauces. It is practically impossible to 

 wound a normal internal carotid artery. In old people the internal carotid sometimes 

 becomes lengthened and tortuous in the same manner as do the temporal arteries. In 

 such cases the artery may form a pulsating swelling behind and projecting farther 

 inward than the edge of the posterior pillar. This I have once seen. It may be 

 mistaken for a true aneurism, as it pulsates and the pulsation is readily stopped by 

 pressure on the common carotid on the outside of the neck. If, however, the possi- 

 bility of this condition is borne in mind, the diagnosis can readily be made. The 

 pulsating swelling can readily be seen and felt with the finger just behind the posterior 

 pillar of the fauces. 



The mucous membrane of the nasopharynx is ciliated columnar; that of the 

 lower portion is squamous. It contains racemose mucous glands and follicles or crypts 

 surrounded by lymphoid tissue. It is well supplied with blood-vessels. It is fre- 

 quently affected by inflammation or pharyngitis. When the follicles are markedly 

 involved they can be seen studded over the posterior wall of the pharynx. This 

 constitutes a follicular pharyngitis. Not infrequently some ulceration may be 

 present, forming an ulcerative pharyngitis. Infection attacks it, as in diphtheritic 

 pharyngitis. Should pus or pharyngeal abscess form around the pharynx, arising 

 from an infection from the oral cavity, the pus occupies the setropharyngeal space 



