1 1 6 The Tongue 



The stylo-glossus arises from the tip of the styloid process and 

 from the stylo-maxillary ligament, and runs with the stylo-pharyngeus, 

 and the glosso-pharyngeal nerve, between the external and internal 

 'carotids, to blend with the upper part of the hyo-glossus and the lin- 

 gualis. It is supplied by the hypoglossal nerve. 



The lin^uaiis, the intrinsic muscle, consists of four sets of striated 

 fibres, namely, a superior and inferior longitudinal, a transverse, and a 

 vertical. The inferior set, the more important, extend from the base 

 of the tongue, and even from the hyoid bone, to the apex, lying between 

 the hyo-glossus and the genio-hyo-glossus, the ranine vessels resting 

 upon them. They help in retraction of the tongue. The transverse 

 fibres pass from the median fibrous septum to the border ; their action 

 is to narrow, and thus help in protruding the tongue. The vertical 

 fibres help to flatten and curl up the tongue. 



Supply of tlie tongue. The arteries are the lingual of the external 

 carotid, and, perhaps, twigs of the ascending pharyngeal and ascend- 

 ing palatine. The veins run to the internal jugular. The lymphatics 

 end in the deep cervical and submaxillary glands. 



Nerves. The gustatory branch of the inferior maxillary, a nerve 

 of common sensation, is distributed to the mucous membrane at the 

 side and tip. The extremely delicate sense of touch of this nerve is 

 utilised by the dealer in precious stones when the eye alone cannot be 

 trusted. Neuralgia of the nerve is sometimes so severe in cancer of 

 the tongue as to demand its section (p. 64). The glosso-pharyngeal 

 is the special nerve of taste behind the circumvallate papillae. The 

 hypoglossal supplies all the muscles, except the lingualis, which re- 

 ceives its stimulus from the chorda tympani (p. 66). 



Excision of the tongue. A strong-looped suture is first passed 

 through each side of the tongue near the tip, the loops being dragged 

 forward and slightly asunder ; then the tongue is split with scissors 

 down the median raphe', and each half is detached from the jaw, and 

 from the floor of the mouth, by short snips with blunt-ended scissors. 

 The loop of the ecraseur is then passed far back, and fixed round one 

 half by a firm pin, and as the wire is slowly tightened up the mass is cut 

 through without loss of blood, the tough lingual artery being dragged 

 out entire. The evulsed artery is then tied and divided ; if necessary, 

 the other half of the tongue is then similarly treated. Sometimes one 

 of the lingual arteries is found quite small. 



When the lymphatic glands and the jaw are implicated the opera- 

 tion is much more serious, and must be commenced by an incision 

 from the front of the sterno-mastoid down to the hyoid bone and up 

 to the symphysis, laryngotomy having first been performed. In one 

 case in which I thus proceeded in the removal of advanced cancerous 

 disease I had to tie the external carotid, and, before the operation 

 was finished, I had removed the side of the pharynx and the tonsil. 

 The structures divided in an ordinary excision are the mucous 



