430 



SALIVARY GLANDS. 



and its absence or mere rudimentary condition 

 in those that swallow without masticating. 

 Its comparative smallness, in relation to the 

 submaxillary and sublingual in the human in- 

 fant, is also corroborative. 



Without entering into the physiology of 

 the secretion of the saliva, which will be 

 found treated of elsewhere (see SALIVA, SE- 

 CRETION), it may be interesting to remark, 

 that the salivary glands, although immediately 

 surrounded by muscles, are not necessarily 

 compressed in the different movements of the 

 jaw. This conclusion has been arrived at by 

 a series of interesting experiments and in- 

 ductions due to Bordeu, but into the analysis 

 of which it would be beyond the limits of this 

 article to enter.* 



MORBID ANATOMY. The parotid gland is 

 far more frequently the subject of disease than 

 either the submaxillary or sublingual. The 

 idiopathic inflammation of these glands is 

 known under the name of Cynanche parotidea, 

 vulgarly translated " mumps." The submaxil- 

 lary is occasionally, and the sublingual but 

 rarely implicated. The surrounding soft parts, 

 particularly the lymphatic glands, participate 

 in the inflammation, tending greatly to increase 

 the swelling. On account of the intimate 

 relation of the glands with the jaw, consider- 

 able pain and inconvenience form a prominent 

 symptom. The saliva is at first increased, 

 and subsequently diminished in quantity. 

 Suppuration very rarely occurs. Secondary 

 inflammation takes place as an occasional com- 

 plication of the different forms of fever. In 

 eighteen cases of typhoid Louis observed one 

 in which the parotid was implicated. The 

 man died on the thirty-ninth day of the 

 attack ; and nine days prior to death pain 

 supervened in the parotid glands, which were 

 found after death to be twice their ordinary 

 volume, and studded throughout with small 

 purulent deposits. 



The chief point of interest, however, to the 

 surgeon and anatomist, in connection with 

 inflammation of the parotid, is the formation 

 of abscess in the region of the gland. This 

 may either take place in the subcutaneous 

 cellular tissue superficial to the parotid fascia, 

 or in the substance of the gland beneath that 

 fascia. It generally occurs, in the one form 

 or the other, in connection with phlegmonous 

 erysipelas of the face and neck. Abscesses 

 forming in the latter situation demand the 

 prompt attention of the surgeon, inasmuch as 

 they are attended with the most severe con- 

 stitutional symptoms, which are only relieved 

 by a free incision through the dense fibrous 

 envelope of the gland : unless thus treated, 

 the matter either makes its way through the 

 external auditory canal, by passing between 

 its bony and cartilaginous divisions, or, after 

 the most severe symptoms, bursts externally 

 in the parotid region. It may even extend 

 deeply into the neck as far as the trachea, 

 and terminate by effusion into the chest and 



* Bordeu, Recherches Anatomiqnes stir la Position 

 des Glandes, et sur Icur Action. Paris, An. viii. 



death. Independent of this extensive bur- 

 rowing, matter pent up beneath the parotid 

 fascia may exert a most injurious influence by 

 compression of the larger vessels of the neck, 

 the structure of the gland itself, and the facial 

 nerve. Examples, in fact, are on record of 

 almost complete destruction of the gland itself, 

 and incurable facial paralysis, from neglect of 

 incising the parotid fascia at an early period 

 of the formation of pus beneath it. 



In inflammation of the salivary glands, 

 whether primary or secondary, the areolar 

 tissue of the gland is most usually affected ; 

 in a few instances, however, the true structure 

 of the gland is implicated. Berard * relates 

 a remarkable instance of this k'ind, in which 

 both the areolar and glandular tissue were 

 affected. When the parotid was pressed, pus 

 flowed into the mouth from Steno's duct. 



Abscesses connected with disease of the ear 

 now and then make their way into the sub- 

 stance of the parotid gland. 



Encysted tumours are occasionally observed 

 in the body of the parotid, and in all pro- 

 bability are more in connection with the 

 lymphatic glands than the gland itself, except 

 in those cases where they arise from isolated 

 collections of saliva, owing to obstruction in 

 some part of the excretory canal. The latter 

 formations are, however, but rarely met with, 

 and, when so, occur usually in the track of 

 Steno's duct. 



The parotid and submaxillary undergo also 

 fibrous and carcinomatous degeneration. The 

 latter affection, as a purely idiopathic change, 

 is extremely rare ; and, although the records 

 of surgery afford ample illustration of such in 

 the parotid, according to the assertions of 

 the authors of individual cases, the evidence 

 in some must be received with considerable 

 reserve. Carcinoma originating in the lym- 

 phatic glands, superficially to or beneath the 

 parotid fascia, or, lastly, in the paren- 

 chyma of the gland itself, has been, in fact, 

 indiscriminately described as carcinoma of the 

 parotid gland. This subject has been minutely 

 inquired into by Berard, as also the extir- 

 pation of the gland f in a great number of the 

 cases on record. He concludes his observa- 

 tions, by remarking that scirrhus of the parotid 

 generally calls for the extirpation of the parts 

 affected ; and supports this conclusion by ob- 

 serving, that relapses after the operation are 

 comparatively rare. This inference is at 

 variance with the opinion of many practical 

 surgeons ; and it would require a much more 

 extensive and impartial series of statistics 

 than we at present possess to arrive at a 

 definite conclusion on the subject. No greater 

 difficulty exists than to obtain the subsequent 

 history of apparently successful cases in sur- 

 gery, and that of those in which the parotid 

 has been extirpated forms no exception to 

 the remark. In the case related by Mr. Luke J 9 



* Berard, Maladies de la Glande Farotide, et de la 

 Region Parotidienne. 8vo. Paris, 1841. 

 t Loc, cit. 

 j London Medical Gazette, Feb. 5, 1831. 



