n6 SURGICAL APPLIED ANATOMY. [Chap. vm. 



it is the subject of other than malignant enlargement, 

 can ever be felt externally. When hypertrophied, the 

 mass tends to develop towards the middle line, where 

 no resistance is encountered, and to effect but little 

 change in its external relations. The mass, often mis- 

 taken for the enlarged tonsil in the neck, is formed of 

 enlarged glands, situate near the tip of the great cornu 

 of the hyoid bone. These glands receive the tonsillar 

 lymphatics, and are almost invariably enlarged in all 

 tonsil affections. It must be remembered that many 

 structures are interposed between the tonsil and the 

 skin, and as the hypertrophied body projects freely 

 into the pharyngeal cavity, one would not expect that 

 it could be readily felt, even were the interposed 

 tissues less extensive than they are. The tonsil is 

 closely enough attacned to the pharyngeal wall to be 

 affected by the movements of the pharyngeal muscles. 

 Thus it is moved inwards by the superior con- 

 strictor muscle during the act of swallowing, and may 

 be drawn outwards, on the other hand, by the stylo- 

 pharyngeus muscle. The ease with which a tonsil can 

 be reached depends, other things being equal, upon 

 the extent to which it can be withdrawn by the stylo- 

 pharyngeus, and upon the development of the anterior 

 palatine arch, which, to some extent, hides the tonsil. 

 A child with a prominent anterior palatine arch, con- 

 taining a well-developed palato-glossus muscle, and 

 with a vigorous stylo-pharyngeus, can for a long time 

 elude the tonsil guillotine. 



Deafness is often complained of when the tonsil is 

 hypertrophied. This is not due to closure of the 

 Eustachian tube by the direct pressure of the enlarged 

 mass. Such pressure is anatomically impossible. The 

 large tonsil may, however, affect the patency of the 

 tube, by disturbing the soft palate, and through it the 

 tensor palati muscle, which is much concerned in keep- 

 ing often the Eustachian tube. The deafness in these 



