LINGUAL CAECINOMA. 347 



salivary gland. Hence it is not altogether easy to thoroughly 

 eradicate them without at the same time extracting the salivary 

 gland. No hesitation should be felt in doing so as the other 

 glands are amply sufficient to keep the mouth moist, and the 

 wound does not as a matter of experience become infected from 

 the mouth along that part of Wharton's duct which is left 

 behind. 



The same incision which is made for the removal of the glands 

 before excision of the tongue can be utilised for ligature of the 

 lingual artery. If this vessel is tied where it lies under cover of 

 the hyo-glossus muscle, it should be recollected that its direction 

 is much more nearly vertical than horizontal, and great care 

 must be taken not to miss the artery and pass through the 

 middle constrictor, and so open into the pharynx and provide a 

 pathway for infection into the cervical wound. Ligature of 

 the lingual artery beneath the hyo-glossus does not cut off 

 the blood supply to the dorsum of the tongue near its base, 

 seeing that the dorsalis linguae branch arises behind the pos- 

 terior border of the hyo-glossus. It is well, therefore, if the 

 tongue or half of it is to be removed far back, to ligature the 

 lingual soon after its origin from the external carotid. In cases 

 of primary or secondary haemorrhage from the lingual when it 

 has been tied in the floor of the mouth, arrest of the bloodflow 

 may be easily brought about temporarily by drawing forward 

 the base of the tongue with the finger and pressing it against 

 the body of the mandible. This temporary arrest may need to 

 be followed by ligature of the external carotid. The artery 

 should be secured distal to the origin of the superior thyroid 

 branch, so as to eliminate the free communication between the 

 inferior and superior thyroid arteries. 



THE TONSILS. 



Tonsillitis. The palatine tonsils are placed in an extremely 

 exposed position, for they may be infected both by the passage 

 of air or food over them. The air which is unnaturally drawn 



