eing
enlarged if necessary.

If the food and air-passages are intact, any muscles that have been
divided should be sutured.

When the epiglottis is cut across in wounds opening into the pharynx,
it should be united, preferably with fine silk sutures, as catgut is
absorbed before healing has time to take place. The wall of the
pharynx and the muscles should then be sutured layer by layer.

When the air-passage is opened, it is usually advisable to introduce a
tracheotomy tube (Fig. 273), and pack gauze round it to avoid the
risk of oedema of the glottis and to prevent blood entering the lungs.
The soft tissues may then be brought together layer by layer.

[Illustration: FIG. 273.--Recovery from Suicidal Cut-throat after low
tracheotomy and gastrostomy.

(Mr. J. M. Graham's case.)]

In all cases the superficial part of the wound should be drained, and
in applying the bandage the head should be flexed on the chest to take
all tension off the stitches. The patient must be kept under constant
supervision lest he should interfere with the dressings, or make a
further attempt on his life. In some cases it is necessary to feed him
through a tube passed into the stomach either through the mouth or
through the nose; when this is not feasible, nourishment must be given
by the rectum, or by a gastrostomy tube (Fig. 273).

_Wounds of the thoracic duct_ have been described with affections of
the lymphatics (Volume I., p. 324), and _wounds of the brachial
plexus_ with injuries of individual nerves (Volume I., p. 360).

INFECTIVE CONDITIONS

#Cellulitis# may occur in any of the cellular planes in the neck, the
most important form being that which occurs under the cervical fascia,
for example in the course of acute infective diseases, such as scarlet
fever, measles, or pyaemia. The pus tends to spread widely throughout
the neck, infiltrating the connective-tissue spaces around the blood
vessels, the air-passages, and the oesophagus. The density and tension
of the cervical fascia cause the pus to burrow downwards towards the
mediastinal spaces of the thorax, where it may give rise to such
complications as empyema, infective pericarditis, or gangrene of the
lung. The pus may also reach the axilla by spread of the infection
along the subclavian vessels.

An acute phlegmonous peri-adenitis sometimes occurs in the loose
cellular tissue around the submaxillary gland, and spreads with great
rapidity through the cellular planes o