II. OPERATIONS ON THE NECK. 



12. OPENING OF THE GUTTURAL POUCHES. 



Plate XIV. 



Instruments. Razor, Scissors, convex sharp-pointed 

 and straight probe-pointed scalpels, artery forceps, tenacula, 

 probe, trocar, curette, drainage tubing, suture and dressing 

 material. 



Technic. I. Viborg^ s method. The operation is possible 

 on the standing animal, but generally the patient must be 

 cast or placed on the operating table and secured in lateral 

 decubitis with the head extended. B}^ extending the head 

 and compressing the jugular vein there is brought out the 

 triangle immediately behind the posterior border of the in- 

 ferior maxilla and below the parotid gland comprised be- 

 tween the posterior angle of the inferior maxilla, the 

 terminal tendon of the sterno-maxillaris muscle and the 

 external maxillary vein. 



In this so-called Viborg's triangle after the removal of 

 the hair and the disinfection of the skin which is maintained 

 stretched, make a 5 cm. long incision through the skin and 

 skin muscle immediately beneath the aforementioned tendon 

 and parallel to it. In case of pronounced swelling in 

 Viborg's triangle the operator must determine the location 

 for the incision by the position of the sterno-maxillaris 

 muscle. The skin, subcutem and cervical fascia having 

 been incised to a sufficient extent, force a passage with the 

 finger or with closed probe pointed scissors or other blunt 

 instrument through the loose connective tissue on the 

 median side of the parotid gland, to the guttural pouch and 

 penetrate it at its lowest point with the finger or trocar. 

 In order to open the empty guttural pouch as an exercise 

 operation it is desirable to grasp a portion of its wall by 

 means of forceps. Through the operative wound a drainage 



