146 SURGICAL APPLIED ANATOMY. [Chap. ix. 



glands (upper set). Some lymphatics from posterior 

 part of the fossae enter the parotid glands. * 



Branchial fistulae. Certain congenital fistulas 

 are sometimes met with in the neck, which are due to 

 partial persistence of one of the branchial clefts. 

 These clefts are placed in the fostus between the 

 branchial arches. The arches are usually described 

 as five in number. The first lays the foundation for 

 the lower jaw. From the second are developed the 

 incus, the styloid process, the stylo-hyoid ligament 

 and lesser cornu of the hyoid bone. From the third 

 is formed the body and greater cornu of the 

 hyoid bone, while the fourth and fifth take part 

 in the formation of the soft parts of the neck 

 below the hyoid bone. The first cleft is between 

 the first and second arches. " The cervical branchial 

 fistulas appear congenitally as very fine canals 

 opening into minute orifices in one or both sides 

 of the fore part of the neck, and leading backwards 

 and inwards or backwards and upwards towards 

 the pharynx or oasophagus " (Paget). Their length is 

 about 1J to 2^ inches, and their diameter varies from 

 that of a bristle to that of an ordinary probe. They 

 usually exist about the line of the third or fourth 

 cleft, and are most often met with just above the 

 sterno-clavicular joint. Others are found about the 

 level of the top of the thyroid cartilage at the anterior 

 edge of the sterno-mastoid muscle. It would appear 

 that certain poly cystic congenital tumours, occurring 

 as one form of " hydrocele of the neck," may be de- 

 veloped from an imperfectly closed cleft. I have 

 elsewhere detailed the dissection of one of these 

 tumours that appeared to be associated with a partially 

 closed second branchial cleft (Path. Soc. Trans., 1881). 



* From " Scrofula, and its Gland Diseases," by the Author. 



