16 SUPERFICIAL ANATOMY OF THE HEAD AND NECK. 



On putting back the head, the mucous membrane covering the hard palate, and 

 the soft palate come into view, as well as the uvula, the anterior and posterior pillars 

 of the fauces, and the tonsils. The hamular process is plainly felt a little behind 

 and internal to the last molar tooth ; and just in front of this is situated the opening 

 of the posterior palatine canal, through which the largest vessels and nerves of the 

 palate issue. The pterygo- maxillary ligament is to be felt descending from the 

 hamular process to the inferior maxilla, being contained in a more or less prominent 

 fold of the mucous membrane, which passes between the jaws behind the extremities 

 of the dental arches. Just in front of this, and immediately internal to the last 

 molar tooth, the lingual branch of the fifth nerve runs inwards beneath the mucous 

 membrane to the side of the tongue. 



Between the posterior pillars of the fauces, a portion of the mucous lining of the 

 hinder wall of the pharynx is seen ; and if the finger be passed behind the tongue, 

 there is no difficulty in feeling the greater part of the back of the pharynx and the 

 epiglottis. By hooking the finger up behind the soft palate, the basilar process of 

 the occipital bone is reached, and the posterior nares and adjacent parts may be 

 explored. It is easy thus to distinguish the vault of the pharynx, the septum nasi, 

 the posterior extremities of the middle and inferior turbinate bones, and the openings 

 of the Eustachian tubes ; and the finger may be made to pass some distance into 

 the nasal fossae. In this way also the upper four or five (in children six) cervical 

 vertebrae may be examined, the anterior arch of the atlas being opposite the lower 

 margin of the posterior nares, and the body of the axis corresponding to the soft 

 palate. The part of the column which is accessible to a straight instrument 

 introduced through the mouth is very limited, extending in the adult from the 

 lower border of the axis to the middle or lower part of the fourth cervical vertebra ; 

 in the child, owing to the small depth of the face, it comprises the body of the axis 

 and of the third cervical vertebra (Chipault). 



By posterior rhinoscopy the upper parts of the posterior nares are seen, separated 

 by the septum. They are in great part occupied by the posterior ends of the 

 turbinate bodies, of which the most conspicuous is the middle ; the superior is 

 usually seen, but only the upper part of the inferior, the lower part of the latter, as 

 well as the lower part of the septum, being concealed by the soft palate. On each 

 side of the posterior nares are seen the Eustachian tube, the salpingo-pharyngeal 

 and salpingo-palatine folds, and the lateral recess of the pharynx (fossa of Kosen- 

 muller). By turning the mirror upwards, the vault of the pharynx, the pharyngeal 

 tonsil and the median pharyngeal recess (bursa pharyngea) may also be examined. 

 The septum appears whitish, the turbinate bodies are of an ash-grey colour, and the 

 rest of the mucous membrane is of various shades of red. 



THE NECK. 



The front of the neck is divided into an upper, suprahyoid, submaxillary, or hyo- 

 mental region, and a lower, infrahyoid or hyo-sternal region. The hyoid bone, which 

 forms the boundary line between the two divisions, can be felt in the receding angle 

 below the chin, and it may be examined by fixing the two great cornua between the 

 fingers. The anterior bellies of the digastric muscles form the convex surface in 

 the middle of the suprahyoid region, and outside this on each side the submaxillary 

 gland is both to be felt and seen. The median prominence (pomum Adami} in the 

 upper part of the infrahyoid region is due to the thyroid cartilage, and is strongly 

 marked in men, especially those with deep voices, small or indistinct in women and 

 children. Above the thyroid cartilage the finger sinks into the depression (thyro- 

 hyoid space) between that and the hyoid bone ; below the thyroid, the crico-thyroid 

 space and the cricoid cartilage are recognised ; and from the latter the finger passes 

 on to the trachea. The rings of the trachea are, however, scarcely to be distinguished, 



