Landmarks Medical and Surgical

by Luther Holden; James Shuter

19. Mouth.—What can be seen and felt through the mouth? The upper surface of the tongue, ‘speculum primarum viarum,’ is a study in itself. We notice, on its under surface, a median furrow, on each side of which stands out the ranine vein, lying upon the prominent fibres of the lingualis. In the middle line of the floor of the mouth is the ‘frenum linguæ,’ with the orifice of the duct of the submaxillary gland on each side of it. The gland itself can be detected immediately beneath the mucous membrane by feeling further back near the angle of the jaw, at the same time pressing the gland upwards from below.

The long ridge of mucous membrane on each side of the floor contains the sublingual glands.

We can feel the attachment of the ‘genio-hyo-glossi’ behind the symphysis of the jaw. The division of this attachment would enable a surgeon to draw the tongue more freely out of the mouth in any attempt to remove carcinoma extending far back into its root.

There is great difference in the shape of the hard palate; this difference depends upon the depth of the alveolar processes. In some it forms a broad arch; in others it is narrow, and rises almost to a point like a Gothic arch, and materially impairs the tone of the voice.

Throat.—To examine the throat well, the nose should be held so as to compel breathing through the mouth. Thus the soft palate will be raised, the palatine arches widened, and the tonsils and the back of the pharynx fairly exposed. Pressing the tongue downwards, provided it be done very gently, is also of advantage. Rude treatment the tongue at once resists. The forefinger can be passed into the throat, beyond the epiglottis, as low as the bottom of the cricoid cartilage, and thus search the pharynx down to the top of the œsophagus, and the hyoid space (on each side) where foreign bodies are so apt to lodge. The greater cornu of the hyoid bone can be felt as a distinct projection on either side. In introducing a tube into the œsophagus the finger should keep the instrument well against the back of the pharynx so as to prevent its slipping into the larynx.

Pass the finger between the teeth and the cheek and feel the anterior border of the coronoid process of the jaw. On the inner side of this process, between it and the tuberosity of the upper jaw, is a recess, where a deeply-seated temporal abscess might burst, or might be opened. Behind the last molar on the inner side of the upper jaw we can distinctly feel the hamular process of the sphenoid bone; also the lower part of the pterygoid fossa, and the internal pterygoid plate. Behind, and on the outer side of the last molar, can be felt part of the back of the antrum and of the lower part of the external pterygoid plate.

On the roof of the mouth we can feel the pulsation of the posterior palatine artery. Hæmorrhage from this vessel can be arrested by plugging the orifice of the canal, which lies (not far from the surface) on the inner side of the last molar, about 1/3 of an inch in front of the hamular process.

When the mouth is wide open, the pterygo-maxillary ligament forms a prominent fold readily seen and felt beneath the mucous membrane, behind the last molar teeth. A little below the attachment of this ligament to the lower jaw we can easily feel the gustatory nerve, as it runs close to the bone below the last molar tooth. The exact position of the nerve can be ascertained in one’s own person by the acute pain on pressure. A division of the nerve, easily effected by a small incision, gives much temporary relief in cases of advanced carcinoma of the tongue.

To feed a patient in spasmodic closure of the jaw, it is well to know that there is behind the last molar teeth a space sufficient for the passage of a small tube into the mouth.

Antrum.—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.