THE NECK. 1385 



leaving the greater palatine foramina, run forwards in shallow grooves in the hard 

 palate, close to its alveola-r margin. In the operation for cleft "palate (staphylor- 

 raphy], in order to secure nourishment for the muco-periosteal flaps, the lateral 

 incisions should be made lateral to those vessels. 



Secondary haemorrhage after the operation for cleft palate is treated by plugging the 

 greater palatine foramen, which lies a little medial to the last molar tooth about J in. 

 in front of the hamular process, which can be felt at the superior extremity of the fold of 

 mucous membrane containing the pterygo-maxillary ligament. In the closure of a wide 

 cleft of the soft palate the tension of the tensor veil palatini muscle is got rid of by 

 chipping off the hamulus with a small chisel introduced at the posterior extremity of the 

 lateral relief incisions. 



Nasal Part of the Pharynx. To explore the superior or nasal part of the 

 pharynx the finger should be hooked upwards behind the soft palate. Anteriorly, 

 the finger readily detects the sharp posterior border of the vomer, the choanae, 

 and the posterior extremity of the middle and inferior conchse. The roof of the 

 space is formed by the basilar part of 'the occipital bone, while upon the posterior 

 wall is a transverse bony ridge caused by the projection of the anterior arch of the 

 atlas. Upon the side walls of the nasal part of the pharynx are the openings 

 of the auditory tubes, situated J in. behind the posterior extremities of the 

 inferior conchse. The orifices, bounded superiorly and posteriorly by a prominent 

 margin, are directed downwards and forwards, and, therefore, in a direction favour- 

 able to the passage of the Eustachian catheter. Behind the prominent posterior 

 margin of the orifice is the recess of the pharynx (O.T. fossa of Rosenmiiller), 

 in which the point of the Eustachian catheter is apt to become engaged. Upon 

 the roof and posterior wall of the pharynx, down to the level of the anterior 

 arch of the atlas, and extending laterally as far as the orifices of the auditory tubes, 

 is a collection of adenoid tissue, the pharyngeal tonsil. Hypertrophy of this tissue 

 constitutes the condition known as " adenoids" the harmful effects of which are due 

 to their interference with nasal respiration. Upon the centre of the pharyngeal 

 tonsil is an orifice leading into a small recess into which numerous mucous glands 

 open. The structures felt in the post-nasal space may be rendered visible by 

 reflecting the light upon a small mirror placed immediately behind and below; the 

 soft palate (posterior rhinoscopy). The inferior part of the inferior concha is 

 obscured from view by the bulging of the superior surface of the soft palate. 



In plugging the posterior nares, it is important to remember that those openings 

 measure nearly one inch in the vertical and half an inch in the transverse direction. 

 In the child, owing to the small size of the face, the vertical diameter of the naso- 

 pharynx is relatively much smaller than in the adult. 



The lymph vessels from the nasal cavities and pharynx, including the palatine 

 and pharyngeal tonsils, join the sub-parotid and superior deep cervical glands, one 

 of which lies medial to the carotid vessels between the recess of the pharynx 

 and the prevertebral fascia. In children suppuration originating in this gland is 

 the commonest cause of a retro-pharyngeal abscess. 



In the adult the four upper cervical vertebrse can be explored from the mouth, 

 while in the child the finger can also reach as far down as the sixth vertebra and the 

 back of the cricoid cartilage. 



THE NECK. 



The general envelope of deep cervical fascia, along with the processes and partitions 

 which proceed from its deep surface, subdivides the neck into compartments which 

 limit and determine the spread of pus. The most important compartment is the 

 central or visceral compartment, bounded anteriorly by the pretracheal fascia, pos- 

 teriorly by the prevertebral fascia, and laterally by the fascia forming the vascular 

 compartment. Posteriorly, this compartment extends from the base of the skull 

 downwards into the posterior mediastinum ; anteriorly, it extends from the hyoid 

 bone into the anterior part of the superior mediastinum. Abscesses in the visceral 

 compartment are either secondary to disease of the lymph glands or organs it 



