Surgical therapeutics and operative technique . Fig. 279.—Median Paeahyoid Bran-chial Fistula, connected with theForamen C^cum of the Lingual V. Fig. 280.—Median Parahtoid Bban- . CHiAL Fistula, connected with the Foramen C^cum of the Lingual V.: Exploration of the Fistulous Tract with a Filiform Bougie. Tracing of the lozenge-shaped incisionaround the external Fig. 281.—Median Parahtoid Branchial Fistula, connected with the Foramen C^cuM of the Lingual V. The cutaneous orifice has been detached; dissection of the fistulous canal, which is progressively drawn outwards. 166 SURGICAL T
Surgical therapeutics and operative technique . Fig. 279.—Median Paeahyoid Bran-chial Fistula, connected with theForamen C^cum of the Lingual V. Fig. 280.—Median Parahtoid Bban- . CHiAL Fistula, connected with the Foramen C^cum of the Lingual V.: Exploration of the Fistulous Tract with a Filiform Bougie. Tracing of the lozenge-shaped incisionaround the external Fig. 281.—Median Parahtoid Branchial Fistula, connected with the Foramen C^cuM of the Lingual V. The cutaneous orifice has been detached; dissection of the fistulous canal, which is progressively drawn outwards. 166 SURGICAL THERAPEUTICS AND OPERATIVE TECHNIQUE mucous lining with an outer coating of fibro-cellular tissue. In the lowerportion we find squamous epithelium; in the upper segment the lining is ofciliated cylindrical epithelium. The outer coat of the mucous membraneoften presents an adenoid structure. The orifice is usually very small, andis found closed by an epithelial operculum, or with a small yellowish small quantity of liquid mucous fluid escapes, either clear or turbid. Thetract is recognizable on palpation as a hard cord directed towards the greatcornu of the os hyoides. Operation—First Stage.—Vertical elliptical incision around the orificeof the fistula, and liberation of the lower portion of the tract.
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