36 Catarrh of the Guttural Pouch 



12. Catarrh of the Guttural Pouch. Catarrhus sacci aerophori. 



Catarrh of the guttural pouch is a collective name for 

 acute, or more commonly chronic inflammations of the mucosa 

 of the g-uttural pouch, which lead to an accumulation of masses 

 of secretion (empyema sacci aerophori). 



Etiology. Catarrh of the guttural pouch is due only very 

 exceptionally to traumatic insults (penetration of a hall or a 

 spUnter of the fractured lingual hone) or to the penetration of 

 foreign liodies or particles of feed from the pharynx. Whether 

 the moulds found l)y some authors in the guttural pouch were 

 the primary cause of the disease is still an open question. 

 Catarrh of the guttural pouch is as a rule a secondary affection 

 due to catarrhal or more deeply penetrating inflammatory proc- 

 esses of the deeper portions of the nose or of the pharynx, the 

 process spreading along the Eustachian tuhe. Exceptionally 

 severe inflammation of the neighhoring soft parts (parotid 

 gland, retropharyngeal glands) may stand in an etiologic rela- 

 tion to catarrh of the oiittural pouch. The latter affection is 

 only rarely a part of the clinical picture of glanders. 



Anatomical Changes. The mucosa is sometimes reddened, 

 also covered with ulcers; if the case has been long standing, 

 it is thickened and uneven ; frequently mould colonies are found 

 to have developed. The gaittural pouch contains tenacious 

 muco-purulent, occasionally putrid masses in varying amounts, 

 which after desiccation are caseous or more firm (concrementi 

 sacci aerophori) and which have wrongly been called chon- 

 droids or g-utturoliths. The cavity either contains one large 

 mass of this type or a number of them (up to 200). Owing to 

 decomposition of the secretion there may be a collection of gas 

 (meteorisms sacci aerophori), exceptionally the guttural 

 pouch may be filled with a serous fluid (hydrops sacci aero- 

 phori). 



Symptoms. The clinical picture of catarrh of the guttural 

 pouch, particularly in the early stage, is in part similar to that 

 of catarrh of the antrum of Highmore. There is a unilateral 

 mucopurulent or purely purulent nasal discharge, and a 

 gradually increasing, not painful, swelling of the submaxillary 

 lymph glands on the affected side. As the masses of secretion 

 increase, however, the affected jo-^ittural pouch becomes en- 

 larged in the course of time, and a protrusion in the par- 

 otid region becomes visible. The swelling is usually unilat- 

 eral and may reach a variable size ; it completely obliterates tlie 

 depression back of the inferior maxilla, indeed a protrusion 

 may be seen here (see Fig. 4). The latter is usually soft and 

 doughy in consistency and can be made smaller by pressing and 



