Landmarks, medical and surgical / by Luther Holden.

  • Luther Holden
Date:
1877
Catalogue details

Licence: Public Domain Mark

Credit: Landmarks, medical and surgical / by Luther Holden. Source: Wellcome Collection.

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    Posterior nares. Tonsils. To feed a patient in spasmodic closure of the jaw, it is well to know that there exists behind the last molar teeth a space sufficient for the passage of a small tube. Lift up the upper lip and examine the front wall of the antrum. The proper place in which to tap it is above the second bicuspid tooth, about one inch above the margin of the gum. 20. A surgeon's finger should be familiar with the feel of the posterior nares, and of all that is within reach behind the soft palate. This is important in relation to the at- tachment of polypi, to plugging the nostrils, and the proper size of the plug. In the examination of this part of the back of the throat it is necessary to throw the head well back, because, in this position, nearly all the pharynx in front of the basilar process comes down below the level of the hard palate, and can be seen as well as felt. But when the skull is horizontal, i.e. at a right angle with the spine, and the hard palate is on a level with the margin of the foramen magnum, the basilar process is concealed from view. The head, then, being well back, introduce the fore- finger behind the soft palate, and turn it up towards the base of the skull. You feel the strong grip of the superior constrictor. Hooking the finger well forwards, you can feel the contour of the posterior nares. Their size depends upon the anterior, but rarely exceeds a small inch in the long diameter, and a small half-inch in the short. The plug for the posterior nares should not be larger than this. Their plane is not perpendicular, but slopes a little forwards. You can feel the septum formed by the vomer, and also the posterior end of the inferior spongy bone in each , nostril. 21. Before taking leave of the throat, look well at the position of the tonsils between the anterior and posterior half arches of the palate. In a healthy state they should not project beyond the level of these arches. In all opera- tions upon the tonsils, we should remember the close proximity of the internal carotid artery to their outer side.