88_ 



The developmental and growth changes in the structures partic- 

 ipating in the formation of this cavity determine the ultimate form 

 and mouldings of the gland. 



At birth the relatively wide angle of the mandible, the feeble devel- 

 opment of the masticatory muscles as compared for instance with the 

 sucking muscles (Buccinators), the undeveloped mastoid process and 

 its comparatively feeble muscles the Sterno-Mastoid and Digastric, the 

 characters and direction of the cartilaginous External Auditory Meatus, 

 viz. : — in a downward and inward direction, differ very considerably 

 from the conditions present in the adult. With the assumption of 

 the adult features in this region the parotid bed and the gland reach 

 their final form. 



In old age the increase in the angle of the jaw again causes an 

 alteration in size of the parotid bed. 



The removal of the parotid glands entire and a study of the bed 

 is of some surgical interest and importance. The surgery of malig- 

 nant disease of the parotid is yet in its infancy. In Teeves' 

 " Surgical Applied Anatomy," w^e find the statement that — '* entire 

 removal of the gland as a surgical procedure is an anatomical imposs- 

 ibility." Great stress is laid on the close relationship of the gland 

 to the internal carotid, internal jugular vein and the 9 th, iOth and 

 1 1 th cranial nerves ; these structures are said to be merely separated 

 from the gland by a very thin layer of fascia, 



We have indicated above our conclusions as to the relation of 

 the above structures to the gland. We agree with Symington when 

 he says that in removing the gland entire no cranial nerve is injured 

 except the 7 th. In such a procedure no other nerves are seen and 

 the internal carotid and internal jugular and their closely related 

 cranial nerves lie covered by a considerable layer of mesodermal tis- 

 sue and are not exposed unless a special dissection is made. The 

 blood vessels divided, are the external carotid and its terminal branches 

 and the temporo-mandibular vein. 



On anatomical grounds entire removal of the parotid is far less 

 formidable than is generally held. Such a procedure of course would 

 be limited to cases of intra-parotid growths ; a growth which had in- 

 vaded the extra-parotid tissues would render the operation a practical 

 impossibility. 



Faure (11), in an exhaustive memoir on extirpation of the 

 parotid lays stress on the limitation of the operation to cases of intra- 



