OPENING THE GUTTURAL POUCHES. 
119 
inserted into the guttural pouch. This operation has the disadvan¬ 
tage of endangering the nerves and vessels mentioned, nor is the open¬ 
ing into the sac sufficient for the removal of such solid contents as 
chondroids. 
(2) Lecocq recommended that the sac should be entered thiough 
the stylo-hyoid muscle. The procedure is the same as bchabeit s 
method, but the incision is made rather higher. This operation is even 
more objectionable than the last. Not only the external and internal 
carotids, but also the facial and lingual nerves are endangered. The 
risks of such injury are increased by the great swelling and consequent 
abnormal relation "of the parts. Such operations, especially in dead 
animals, can, however, be easily carried out experimentally. 
(B) Viborg recommended opening the sac below from the triangle 
which is formed by the tendon of the sterno-maxillaris muscle and the 
submaxillary vein’ with the border of the lower jaw. In the middle 
of this triangle, and parallel with the muscle named, an incision is 
made in the skin, about 2 to 4 inches in length, and leaching to the 
border of the lower jaw. After separating the panniculus of the neck, 
and dividing the connective tissue, the guttural pouch is perforated 
with a trochar, and the opening can then be enlarged with the fingeis. 
This method has the advantage of opening the pouch at its deepest 
point, thus more easily removing both fluids and solids. The pouch, 
when distended, is easily reached by this method, which, however, is not 
always free from difficulty. As has been shown by Hering, some 
cases of supposed hyovertobrotomy have only been the evacuation of 
a parotid abcess. . 
(4) The following method is probably the best. It is at nist me 
Schabert’s, but the cutaneous incision is carried a little further, extend¬ 
ing over the lower edge of the wing of the atlas. The parotid is 
pushed to one side. The fascia of the throat muscles are cut through, 
bringing in view the stylo-maxillaris, digastricus and occipito-styloid 
muscles. 
Without pushing aside the guttural pouch from the inner face of 
the latter muscle, the two forefingers are inserted, the connective tissue 
pushed on one side, and the space between the styloid process of the 
occipital bone and the posterior surface of the long horn of the hyoid 
is discovered. The forefinger of the left hand is introduced, with 1 s 
volar surface turned towards the point of division, and a sharp pointed 
bistoury slid along the dorsal surface of the finger and passed through 
the occipito-styloid muscle into the guttural pouch. Without removing 
the left hand, the right forefinger is inserted in the sac, and t le e 
immediately follows to enlarge the opening by tearing if found necessary. 
To pass a seton or drainage-tube through the guttural pouch, an 
