Surgical therapeutics and operative technique . ompress, so as to expose the hypoglossal nerve below, and, above it,the posterior belly of the digastric. The artery lies at a depth of somemillimetres. Third —The artery is exposed by detaching the investing cellulartissue with a clawed forceps. It is then raised on a grooved director andtied. Fourth Stage.—Suture of skin and drainage. OPERATIONS ON THE HEAD 151 Extirpation of the Tongue through the Lateral Suj^rahyoid Route. The lateral suprahyoid route permits us to reach the corresponding sideof the^base of the tongue. The approach to
Surgical therapeutics and operative technique . ompress, so as to expose the hypoglossal nerve below, and, above it,the posterior belly of the digastric. The artery lies at a depth of somemillimetres. Third —The artery is exposed by detaching the investing cellulartissue with a clawed forceps. It is then raised on a grooved director andtied. Fourth Stage.—Suture of skin and drainage. OPERATIONS ON THE HEAD 151 Extirpation of the Tongue through the Lateral Suj^rahyoid Route. The lateral suprahyoid route permits us to reach the corresponding sideof the^base of the tongue. The approach to tumours of the base of thetongue in this direction is relatively easy. Operation—First Stage : Incision of the Integuments.—The incisionshould start from the angle of the maxilla, traverse the submaxillary regionobliquely, and end at the vicinity of the os hyoides. It involves skin andplatysma. Second Stage.—Incision of platysma, of the s-uperficial cervical apo-neurosis, extu-pation of the submaxillary and infected lymphatic glands,. Fig. 264.^Dissection of Sublingual and Submaxillaky Space, showing:1Below,THE Digastric; in the Middle, the Divided Edge of the Mtlohtoid;WITH THE Sublingual Gland above it, and the Submaxillary curled]|around ITS JPOSTERIOR MARGIN, The tongue has been drawn out through the wound. double ;ligature of the lingual artery. It often happens that the carotidglands are also involved. In such a case a further incision of 4 or 5 centi-metresshould be made from the posterior extremity of the first, as if forexposure of the external carotid artery. The glands are then extnpated,and the external carotid and its principal branches are tied (see p. 291). Third Stage.^—^The dental arcades are separated with the ringed surgeon recognizes the glosso-gingival groove with his left index-finger,while he explores the depths of the wound with his right, separating thevarious cellular strata till he has reached the mucous membrane. Themylohyoid musc
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