Fig. 64. Situation for Ligature of the Lingual Artery. 



The Subma:\illa>y Region and the surrounding parts are exposed by remo7'al of Platvsina, 

 Lvmpliatic Glands, small Nen<es and Fasciae. The Subina.xillarv Gland has been Ihroivn upwards 

 and appears to be composed of 2 portions, because the Facial Arterv holds the deep portion in 

 position. A piece has been taken out of the Facial Vein : this enables one to throw the gland 

 upwards more easily, and gij'es a belter view 0/ the deep structures. Specimen from a man 



aged 40. 



The Lingual Artery soon disappears, after its origin from the External Carotid, 

 under cover of the Hyoglossus Muscle and runs forwards parallel with the hyoid bone 

 accompanied by two Venae Comites. The course of the Hypoglossal Nerve is similar; 

 the nerve being, however, at a higher level and superficial to the Hyoglossus Muscle. 

 The Sublingual Vein accompanies the nerve. This nerve forms a small A together with 

 the border of the Mylo-Hyoid Muscle and the posterior belly of the Digastric. In this 

 A, the Lingual Artery can be tied, after division or separation of the fibres of the Hyo- 

 glossus Muscle, as shewn in our figure. 



Another point is suitable for ligaturing this artery, which is so frequently tied in 

 operations for removal of the tongue. The vessel may be ligatured in its course between 

 the External Carotid Artery and the border of the Hyoglossus Muscle below the posterior 

 belh' of the Digastric. The place first mentioned is more superficial and more accessible, 

 and would be preferable, if the artery had not given off its main liranches as is fre- 

 quently the case. 



The Facial Artery runs — in a tortuous course — , behind the submaxillary gland, 

 emerging between the gland and the border of the lower jaw (cf. Fig. 63) and extending 

 on to the face along the anterior border of the Masseter. The artery is frequentl}- 

 embedded in the gland and ensheathed by the fascia of the gland. This accounts for 

 the fact, that in removing the subma.xillary gland, the Facial Artery is so often damaged. 

 The Facial Vein passes in front of the gland. 



The Common Carotid Artery bifurcates into Internal and External at the level 

 of the upper border of the Thyreoid Cartilage. On it rests the De.scendens Hypoglossi 

 Nerve. 13ehind the External Carotid, the Superior Laryngeal Nerve (from the Vagus) 

 emerges ; this nerve divides into an outer and an inner branch, the former to supply 

 the Cricothvreoid Muscle, the latter sensation inside the larvnx. 



Fig- ^5- Larynx opened from in front. 



Tlie Laryngeal Region in a man (aged jS^ has been exposed, and the Laryiix slit open in 

 the middle line betiveen the thyreohyoid ligament and the upper border of the cricoid cartilage, 

 a wedge placed between the 2 halves of the thyreoid cartilage keeps the larynx open. (This 



has not been drawn in the figure.) 



This figure shews the aspect seen in Laryngo-fissure or Laryngotomy, an operation 

 which is performed for the removal of Laryngeal Tumours, when the neoplasm cannot 

 be extirpated by the transbuccal endolaryngeal method. 



The middle of the laryngeal region is not covered by muscles. Under the skin, 

 is seen the cervical fascia in its intimate connection with the larynx. Immediately, under 

 the fascia, is the Thyreoid Cartilage. In some cases, there may be a bursa over it. The 

 Anterior Jugular Vein is sometimes very large. There are no other important structures 

 within the area of operation. 



This figure also shews that High Tracheotoni}- is only possible, owing to the 

 position of the thyreoid gland, after the Isthmus of the Thyreoid Gland has been divided 

 or pushed downwards. 



