io8 SURGICAL APPLIED ANATOMY. [Chap. vin. 



portion most conspicuously affected is the base of the 

 tongue, where the lymphatics are usually the most 

 numerous. 



Excision. Many different methods have been 

 adopted for the removal of the entire tongue. It has 

 been removed through the mouth by the ecraseur or 

 the scissors, the latter operation being performed with 

 or without previous ligature of the lingual arteries in 

 the neck. It is difficult, however, to fully expose the 

 deeper attachments of the organ through the com- 

 paratively small orifice of the mouth. To obtain 

 more room the cheek has been slit up in one pro- 

 cedure, while the lower lip and symphysis of the 

 lower jaw have been divided in another. 



In another series of operations the tongue has 

 been reached, or the organ has been fully exposed, by 

 an incision made between the hyoid bone and the 

 inferior maxilla. More recently Kocher has exposed 

 the tongue from the neck, and has reached it by an 

 incision commencing near the ear and following the 

 anterior border of the sterno-mastoid muscle as far 

 as the hyoid bone, whence it turns upwards along the 

 anterior belly of the digastric muscle. 



In the removal of the entire organ, the following 

 parts are of necessity divided : The frsenum, the 

 mucous membrane along the sides of the tongue, the 

 glosso-epiglottic folds, the genio-hyo-glossus, hyo- 

 glossus, stylo-glossus, palato-glossus muscles, the few 

 fibres of the superior and inferior linguales muscles 

 that are attached to the hyoid bone, the terminal 

 branches of the gustatory, glosso-pharyngeal, and hypo- 

 glossal nerves, the lingual vessels, and, at the side of 

 the tongue near its base, some branches of the ascend- 

 ing pharyngeal artery, and of the tonsilar branch of 

 the facial artery. 



The palate. The arch of the hard palate varies 

 in height and shape in different individuals, and it 



