134 SURGICAL APPLIED ANATOMY. [Chap. vin. 



or may cause severe dyspnoea by interference with the 

 larynx. The matter may discharge itself through the 

 mouth, or may reach the neck by passing behind the 

 great vessels and the parotid gland, presenting ulti- 

 mately beneath or at one border of the sterno-mastoid 

 muscle. 



Many structures of importance are in relation with 

 the lateral walls of the pharynx, the principal being the 

 internal cai'otid artery, the vagus, glosso-pharyngeal, 

 and hypoglossal nerves. The internal carotid is so 

 close to the pharynx that its pulsations may be felt 

 by the finger introduced through the mouth. These, 

 and other deep structures in the neck, may be wounded 

 by foreign bodies, that, passing in at the mouth, have 

 been thrust through the pharynx into the cervical 

 tissues. The internal jugular vein is at some distance 

 from the pharynx, especially at its upper part (Fig. 

 13). Langenbeck has three times extirpated the pha- 

 rynx for malignant disease, but without success. He 

 reaches it from the neck through an incision, that, 

 beginning below the jaw, midway between the sym- 

 physis and angle, is carried over the great cornu of 

 the hyoid bone, and ends close to the cricoid cartilage. 

 The posterior belly of the digastric and the stylo-hyoid 

 muscles are detached from the hyoid bone, while the 

 omo-hyoid muscle, the lingual, facial, and superior 

 thyroid arteries, and the superior laryngeal nerve are 

 divided. 



The tonsil is lodged between the anterior and 

 posterior palatine arches. It is in relation externally 

 with the superior constrictor muscle, and corresponds, 

 as regards the surface, to the angle of the lower jaw. 

 It is questionable whether the enlarged tonsil, when 

 it is the subject of other than malignant enlargement, 

 can ever be felt externally. When hypertrophied, the 

 mass tends to develop towards the middle line, where 

 no resistance is encountered, and to effect, but little 



