EVACUATION OF THE GUTTURAL POUCHES 439 



the skin along the posterior border of the inferior maxillary 

 and just anterior to the border of the wing of the atlas. It 

 is intended that the incision should approach the pouch be- 

 tween the jaw and the anterior border of the parotid gland, 

 where it can be safely carried inward without danger of cut- 

 ting any of the large vessels for which the region is noted. 

 The cutaneous incision, to gain a good view of the tissues 

 underlying the skin, should be no less then four inches long 

 and held apart with retractors, as the subjacent dissection 

 proceeds. The incision of the tissues beneath the skin may 

 be much shorter; one inch long is sufficient. It is carried 

 inward with the border of the parotid posteriorly and to the 

 thick edge of the jaw anteriorly, in plain view. As the round 

 stylo-maxillaris muscle comes into view anteriorly just be- 

 neath, the edge of the jaw, the pouch is already open; the 

 finger can be pushed into it, and when distended with purulent 

 products these immediately flow out. The evacuation is 

 effected by pressure, spooning and irrigation. Subsequently, 

 drainage is provided by keeping the incision plugged with 



Fig. 224 — A Pattern of Simple Staphylotomy Knife. 



gauze. Antiseptic irrigations of the pouch with peroxide of 

 hydrogen and mercuric chloride, followed later with astrin- 

 gent washes of zinc sulphate three per cent., should be con- 

 tinued as long as the orifice can be kept open; but as the 

 catarrh of the mucous membrane is not always cured, recur- 

 rence of the trouble may be expected sooner or later. 



Staphylotomy as applied to surgery of the guttural 

 pouches does not refer to incision of the pouch itself, but to 

 slitting the velum for the purpose of admitting the hand 

 into the pharynx with the ulterior object of incising the 

 pouch. The operation is the invention of Wyman, who, in 

 comoany with the author, performed it for the first time in 

 i898?on a large draft horse suffering from an impaction of 

 the left guttural pouch with a quart or more of desiccated 

 pus. The patient, which on account of dyspnoea was in- 

 capacitated, returned to work after three weeks of post- 

 operative convalescence, but continued to cough and dis- 



