CHAPTEE IX. 



OPERATIONS ON THE RESPIRATORY 



APPARATUS. 



ON THE GTJTTUEAL POUCHES— HTOVERTEBROTOMY. 



This term fails to meet the approval of Zundel, who has pro- 

 posed that of Hyo spondylotomy as a substitute, in order the better 

 to indicate the puncture of the sac of the guttural pouches which 

 it signifies. The former name, however, has been generally ac- 

 cepted, and whUe its etymology would point to the operation by 

 which the puncture referred to is made between the hyoid bone 

 and the atlas, it is still used to mean generally, the puncture of 

 the pouches, at whatever point it may be made. 



These guttural pouches, which exist exclusively in the soHpeds, 

 and are two in number, are situated between the cranium, the 

 pharynx and the atlas, resting upon each other on the median 

 Hne, each one, by an expansion of the mucous membrane of the 

 Eustachian tubes, forming a sac and filling the triangular space 

 situated posterior to the pharynx and extending to the larynx. The 

 mucous membrane which forms them is easUy stretched, and the 

 cavity may thus become greatly distended by the accumulation of 

 pus, and when this is the case, the pouch extends below the larynx 

 and the lower extremity of that organ. Thus situated in the parotid 

 region, these two sacs sustain important relations to other points, 

 varjdng according to the position, whether of extension or flexion, 

 of the head upon the neck, and are covered by seven separate 

 tissues, as represented in their order from without inward, by 

 1st, the skin ; 2d, a layer of subcutaneous connective tissue, more 

 or less abundant ; 3d, a thin expansion of cutaneous muscle with 

 the parotido-auricularis muscle; 4th, the parotid gland, whose 

 internal face is moidded upon the muscles and blood vessels un- 

 derneath ; 5th, the following muscles in the order as named from 

 above downward, viz., the small obhque of the head — the stylo- 

 hyoideus, which fiUs the space left between the anterior border of 



