THE FACE, MOUTH AND PHARYNX 189 



lymphoid tissue of the tonsil is extremely common in childhood 

 and youth. The organ may enlarge upwards, downwards, or 

 medially, and may possess either a sessile or a narrow base. 



Modern methods of enucleation of the tonsil endeavour to 

 remove the whole organ, and sometimes the operation is so 

 complete that the pharyngeal aponeurosis is in part taken away 

 and the superior constrictor muscle is exposed. 



The blood-supply of the tonsil is obtained from the external 

 maxillary (facial) through its ascending palatine and tonsillar 

 branches, from the external carotid through the ascending 

 pharyngeal artery, and from the lingual through its dorsales 

 linguae branches. Severe haemorrhage sometimes occurs after 

 enucleation, and it has been attributed (Merkel) to injury of 

 the external maxillary artery. This vessel, however, can only 

 be injured when the muscular wall of the pharynx has been 

 wounded. 



If the operation is performed soon after an attack of acute 

 tonsillitis, the tonsillar arteries are so much enlarged that they 

 may give rise to a haemorrhage so profuse as to suggest injury 

 of some larger vessel. 



The lymph vessels of the palatine tonsil join the upper anterior 

 group of the deep cervical lymph glands. Certain members of 

 this group (p. 133) rapidly become affected in acute tonsillitis, 

 and in malignant disease of the palatine tonsil the glandular 

 enlargement attracts the patient's attention before the throat 

 condition gives rise to any marked symptoms. 



The Pharynx is situated behind the nasal fossae, the mouth, 

 and the larynx. Above, it is roofed in by the base of the skull, 

 and below, it becomes continuous with the oesophagus opposite 

 the sixth cervical vertebra. Its lateral and posterior walls are 

 supported by the constrictor muscles (p. 190), which are covered 

 externally by the bucco-pharyngeal fascia. Its anterior wall 

 is interrupted by the choanae (posterior nares), the isthmus 

 faucium, and the upper laryngeal aperture (Fig. 50). Below 

 the last-named it is only separated from the muscles on the 

 posterior surfaces of the cricoid and arytenoid cartilages by the 

 mucous membrane. 



The Nasal Pharynx is bounded below by the soft palate, 

 and it can be examined by the finger, introduced through the 

 mouth, and carried upwards behind that structure. On its 

 anterior wall the posterior border of the nasal septum (p. 194) 

 can be felt, and on either side of it the finger can be passed 



