266 CLINICAL APPLIED ANATOMY. 



bone when the incision is made from the inside, or the opening 

 made well in front of the masseter if it passes through the 

 skin. The coronary branches of the facial artery supply 

 the upper and lower lips, and troublesome haemorrhage may 

 occur from the superior during an operation upon a hare-lip, 

 or from either after a laceration of the fraenum of the upper 

 or the lower lip. The removal of an epithelioma from the lower 

 lip will necessitate division and ligature of the inferior coronary 

 vessels. 



The lingual artery or its branches may be damaged in wounds 

 of the tongue. As a rule the bleeding vessel can be secured 

 by ligature, or the haemorrhage, if only slight, controlled by the 

 insertion of a suture. There is little, if any anastomosis 

 between the arteries of the two sides except about the tip of 

 the tongue, so that incisions made in the middle line bleed but 

 little. 



The occipital artery is deeply placed as it passes backwards 

 before turning upwards on to the scalp, and in this situation a 

 punctured wound may give rise to troublesome haemorrhage. 

 To expose the bleeding point it may be necessary to divide the 

 fibres of the sterno-mastoid, the splenius capitis, the trachelo- 

 mastoid and even the posterior belly of the diagastric. Its 

 descending branch, the arteria princeps cervicis, may also be 

 injured in the posterior triangle of the neck. 



Injuries about the tonsil and the lateral wall of the pharynx, 

 particularly if of the nature of punctured wounds, may be as- 

 sociated with severe hsemorrhage. It is, however, seldom that 

 such a large vessel as the internal carotid is opened up, seeing 

 that its position in the adult is at least one inch from the mucous 

 surface of this region. More usually the facial or one of its 

 tonsillar branches, or the ascending pharyngeal, is the arterial 

 vessel which is wounded. 



In haemorrhage from any of the branches of the external 

 carotid artery distal to the superior thyroid, if the bleeding point 

 cannot be secured directly, it will become necessary to ligature 

 the main trunk of the external carotid. Because of the very free 



