460 OPERATIONS ON THE RESPIRATORY APPARATUS. 



hyoideus, whicli is readily identified by feeling for the styloid pro- 

 cess of the occipital bone and the superior border of the long 

 branch of the hyoid. Some little hemorrhage and some strug- 

 gling of the patient may follow this incision, caused by the divis- 

 ion of the auricular vein and nerve, but the consequences will not 

 be serious. 



2d. Puncture of the Pouch through the Muscle. — The central 

 point of the muscle being identified, the operator, with a straight 

 bistoury held in the manner of a writing-pen, introduces it under 

 the parotid, obliquely, from above downward, and from behind 

 forward, and thus divides the muscle through and through, and 

 penetrates the pouch. If the puncture proves to be sufficiently 

 large, the index finger is introduced into the opening for explora- 

 tion, and, if necessary, for its further dilatation. 



If the collection of pus is not very abundant, and the mucous 

 membrane lining the sac not greatly distended, it will be important 

 to have a very sharp-pointed instrument, which will make its work 

 of incision sure, instead of merely pushing the membrane away 

 from the internal face of the muscle — an accident which might 

 lead to serious results. 



But again, when the collection is abundant and the pouches 

 much distended, the use of the bistoury may prove unnecessary, 

 the puncture being then readily made by pushing the index finger 

 through both the muscle and the mucous membi'ane of the pouch. 



3d. Making a Counter-Opening. — The S probe, or curved tro- 

 car (Fig. 398), is introduced through the opening made, and is 

 pushed down to the bottom of the pouch, where the mucous mem- 

 brane is easily torn ; it is then carefully directed toward a point a 

 little below the glosso-facial branch of the jugular, back of the 

 thick border of the maxillary bone, and pushing against it with 

 sufficient force, the instrument forms a prominent point under 

 the skin. If the S probe is used, an incision is made with the 

 bistoury through the skin, and the instrument is exposed. If the 

 curved trocar, it is by a strong pushing movement j^assed thi-ough 

 the skin and brought outside. Whatever instrument may be used, 

 a piece of tape or kind of seton is introduced from the lower 

 through the upper opening, and the continued escape of pus thus 

 facihtated and ensured. The extremities of this piece of tape are 

 secured together by tying them with the knot used with the or- 

 dinary seton. 



