CHAPTER IX. 



OPERATIONS ON THE RESPIRATORY 

 APPARATUS. 



ON THE GUTTURAL POUCHES— HYOVERTEBROTOMY. 



This term fails to meet the approval of Zundel, who has pro- 

 posed that of Ilyosjyondylotomy as a substitute, in order the better 

 to indicate the puncture of the sac of the guttural pouches which 

 it signifies. The former name, however, has been generally ac- 

 cepted, and while its etymology would point to the operation by 

 which the punctiu'e referred to is made between the hyoid bone 

 and the atlas, it is still used to mean generally, the puncture of 

 the pouches, at whatever point it may be made. 



These guttural pouches, which exist exclusively in the sohpeds, 

 and are two in number, are situated between the cranium, the 

 pharvTix and the atlas, resting upon each otlaer on the median 

 Hne, each one, by an expansion of the miicous membrane of the 

 Eustachian tubes, forming a sac and filling the triangular space 

 situated jiosterior to the phar^Tix and extending to the larynx. The 

 mucous membrane which forms them is easily stretched, and the 

 cavity may thus become greatly distended by the accumulation of 

 pus, and when this is the case, the pouch extends below the larynx 

 and the lower extremity of that organ. Thus situated in the parotid 

 region, these two sacs sustain important relations to other points, 

 varying according to -the position, whether of extension or flexion, 

 of the head uj^on the neck, and are covered by seven separate 

 tissues, as represented in theu' order from without inward, by 

 1st, the skin ; 2d, a layer of subcutaneous connective tissue, more 

 or less abundant ; 3d, a thin expansion of cutaneous muscle with 

 the parotido-auricularis muscle ; 4th, the parotid gland, whose 

 internal face is moulded upon the muscles and blood vessels un- 

 derneath ; 5th, the following muscles in the order as named from 

 above downward, viz., the small oblique of the head — the stylo- 

 hyoideus, which fills the space left between the anterior border of 



