74 SURGICAL ANATOMY OF 



mediately before it passes behind the outer border of the 

 hyo-glossus muscle, as it is there most accessible ; and to 

 reach it, an incision is to be made about a finger's breadth 

 below the body of the jaw through the integument and 

 aponeurosis, and the gland is to be lifted upwards. After 

 the posterior portion of the capsule of the gland has been 

 divided, the combined lingual and facial veins are seen 

 passing obliquely backwards, and deeper, the hypo- 

 glossal nerve ; at the angle where this nerve meets the 

 tendon of the digastric, lies the artery, taking a curve 

 downwards towards the hyoid bone. Occasionally the 

 vessel pierces the hyo-glossus muscle, or this muscle ex- 

 tends farther back than usual, in which case its fibres 

 must be divided. On the dead body the vessel appears 

 to be tolerably near the surface, but during life the fascia 

 and integuments are so on the stretch and so attached 

 to the salient parts of the region, that when the vessel 

 is exposed, it is actually very deep. The operation is a 

 difficult one, the vessel being only supported by the loose 

 wall of the pharynx, which runs considerable danger of 

 being wounded, so that the only sure firm guide to it is 

 the posterior cornu of the hyoid bone. The hyoid bone 

 may be with advantage drawn forwards into the wound 

 and steadied with a hook (vide Eegion of Tongue). 



Veins. There is often a considerable plexus of veins 

 in this region, the most important being the facial and 

 the lingual ; the facial leaves its artery and passes upon 

 the fascia in front of the submaxillary gland, whilst 

 the lingual vein is separated from its artery by the hyo- 

 glossus muscle. Very often these veins form a common 

 trunk, lying superficial to the hypoglossal nerve, before 

 entering the jugular vein. 



Nerves. The superficial nerves have been already 



