1384 



SUKFACE AND SUKGICAL ANATOMY. 



be felt from the outside. Each tonsil is covered, on its free surface, by mucous 

 membrane upon which are seen the orifices of the tonsillar crypts ; the lateral or 

 deep surface is covered by a layer of fibrous tissue which forms an imperfect 

 capsule to the organ. According to Merkel, the internal carotid artery is situated 

 1*5 cm. behind the lateral margin of the tonsil, which is separated from the superior 

 constrictor by a quantity of loose cellular tissue and fat, so that the gland can be 

 grasped with a volsellum and pulled forwards without dragging the vessel with it. 

 The tonsil receives its Uood-supply mainly from a small vessel derived from the 

 anterior palatine artery ; when this branch is larger than usual and adherent to 



Hypoglossal nerve 



Internal carotid artery 



Vagus nerve 

 | | Sympathetic 



Ascending pharyngeal artery 



Internal jugular vein 

 Accessory nerve 

 Digastric muscle | | 



Dens 



Stylo-hyoid 



Glosso- 



pharyngeal nerve 



Parotid gland 



Temporo- 



maxillary vein 



External carotid 



artery 



Styloglossus 



Ascending 

 palatine artery 



Internal pterygoid 



Epiglottis 



Glosso- 



epiglottic 



fold 



Masseter 



Pharyngeal portion 

 of tongue 



Retro-pharyngeal 

 lymph gland 



Superior 



constrictor muscle 

 Pharyngo-palatine 

 arch 



Palatine tonsil 



Pharyngo-epiglottic 

 fold 



Glosso-palatine arch 

 Vallate papillse 



Raphe of tongue 

 Conical papillse 



Fungiform papilla 

 Buccinator 



Fungiform papilla 



FIG. 1085. HORIZONTAL SECTION THROUGH MOUTH AND PHARYNX AT THE LEVEL OF THE TONSILS. 



The stylopharyngeus, which is shown immediately to the inner side of the external carotid artery, and the 

 prevertebral muscles, are not indicated by reference lines. (From Birmingham). 



the capsule of the tonsil the bleeding which attends the operation of removal of 

 the tonsils may be considerable. The haemorrhage can be arrested by pressing the 

 bleeding point outwards against the internal pterygoid and the ramusof the mandible, 

 f the bleeding be from a spurting vessel of larger size, its source, according to 

 Merkel, is probably the external maxillary artery, which has been wounded as it 

 arches upwards beneath the digastric and stylo-hyoid muscles to within a short 

 distance from the lateral surface of the tonsil. In children and adolescents the 

 tonsils are frequently hypertrophied ; the enlargement may be either general, more 

 towards the median line, downwards along the pharynx, or upwards behind the soft 

 palate ; to expose and thoroughly remove the last-mentioned variety of enlarge- 

 ment the upper part of the glosso-palatine arch must be divided. 



The mucous membrane and the periosteum of the hard palate are so closely 

 united as to form practically one membrane. The greater palatine arteries, after 



