GUIDE TO THE HEAD AND NECK 1585 



vertical incision along its posterior wall, and (2) a transverse incision close to 

 the base of the skull. The soft palate is to be studied, and the divisions of 

 the pharynx noted, namely, the naso-pharynx, above the soft palate, and 

 the buccal and laryngeal divisions below it. In connection with the naso- 

 pharynx the posterior nares and the orifices of the two Eustachian tubes are 

 to receive careful attention. The lateral pharyngeal recess, or fossa of 

 Rosenmiiller, on the lateral wall of the naso-pharynx, is to be noted, and the 

 pharyngeal tonsil at the upper and back part, unless the median vertical 

 incision has interfered with it. The phar>Tigeal bursa, below the pharyngeal 

 tonsil, is also to be examined. The isthmus faucium, superior aperture of 

 the larynx, and oesophagus are next to be examined. 



The soft palate is now to receive careful attention. The anterior and pos- 

 terior pUlars of the fauces are to be carefully examined, together with the 

 uvula. The tonsU, lying between the anterior and posterior pillars, is to 

 receive attention, and the supratonsillar fossa may be noted. The actual 

 dissection of the tonsil, however, is to be postponed till the muscles of the soft 

 palate have been dissected. The levator palati and tensor palati muscles 

 are now to be fully dissected. The relation of the levator palati to the mem- 

 branous floor of the lower part of the Eustachian tube is to be carefully 

 studied. The relation of the tensor palati to the hamular process of the 

 internal pterygoid plate of the sphenoid bone is to be specially noted. The 

 palato-glossus and palato-phar>Tigeus muscles are to be dissected, and in 

 connection with the latter muscle the salpingo-pharyngeus is to be looked 

 for, descending from the lower part of the cartilage of the Eustachian tube. 

 The dissection of the muscles of the soft palate is to be completed by showing 

 the azygos uvulae, and the tonsil is then to be dissected. 



The mouth is to be carefully examined in detail. Its two divisions, namely, 

 the vestibule and mouth proper, will have been under observation at a previous 

 stage of the dissection. The tongue is to receive very careful attention. At 

 its root will be seen the epiglottis and the folds of mucous membrane in this 

 region, namely, median and two lateral, with the glosso-epiglottidean pouch, 

 or vallecula, on either side of the median fold, are to be noted. The fold, 

 known as the frenum linguae, should be carefully examined. It will be found 

 on the under surface of the tongue a little distance from the tip. Close to 

 each side of the frenum will be seen a small papilla, bearing the orifice of 

 Wharton's duct, and near to this the orifice of the duct of Rivini or of Bar- 

 tholin. A little posterior to this is the fold, known as the plica sublingualis, 

 produced by the sublingual gland, and bearing the orifices of the majority of 

 the ducts of Walther (sublingual ducts) . In connection with the tongue the 

 three sets of papillae, namely, conical (and filiform), fungiform, and circum- 

 vallate are to be noted. The V-shaped arrangement of the latter will 

 attract notice, and attention is to be given to the foramen caecum. The 

 limitation of the papillae to the anterior two-thirds of the tongue will be 

 evident. The extrinsic muscles of the tongue are now to be carefully revised, 

 and their dissection completed if necessary. The intrinsic muscles of the 

 organ fall now to be dissected, namely, the lingualis superficialis, lingualis 

 inferior, lingualis trajisversus, and linguahs verticalis. The ranine artery 

 having been alreauiy dissected, the dissector should revise with the utmost 

 care the nerves which aire distiibuted to the tongue. 



Nasal Cavities. — To expose these cavities the skull is to be sa\^Ti through 

 vertically on one side of the median line. The septum nasi now admits of full 

 study. Descending upon it, in a forward direction, will be found the naso- 

 palatine nerve, or nerve of Cotunnius, from Meckel's ganglion, and accompany- 

 ing this nerve may be seen the naso-palatine branch of the spheno-palatine 

 artery. An effort should be made to follow the palatine branch of the naso- 

 palatine nerve through the foramen of Scarpa to the anterior pau-t of the 

 hard palate. 



The outer wall of the nasal fossa should be studied with the closest atten- 

 tion. The three meatus — superior, middle, and inferior — and the three 

 conchae (turbinate bones) admit of easy examination. The openings into the 

 various meatus are to be inspected and compaired with the descriptions given 



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