or 

 LIGA TION OF THE PAROflf^fJVCT. 41 



ance to the depth of about 2 cm. making the bottom of the 

 groove as near as possible on a level with the bottom of the 

 wound in the soft tissues as indicated by the dotted line, AA, 

 Plate VII. Using Liter's forceps as a curette detach all 

 vestiges of the neck ligament from the base of the occiput 

 and leave the bone bare and smooth. Be careful to avoid 

 penetrating the cranial cavity or the occipito-atloid articula- 

 tion. Control the hemorrhage, cleanse and disinfect the 

 wound, pack with iodoform gauze and sutine for its entire 

 length except the anterior part where the packing should 

 slightly protrude and dust the margin of the wound over 

 with iodoform and tannin. Remove the pack after forty - 

 eight hours and dress antiseptically daily. The sutures may 

 or may not be removed according to conditions. In carrying 

 out this operation our chief aim should be to remove all 

 diseased parts, to afford perfect drainage anteriorly, to secure 

 and maintain asepsis, and to keep the wound directly on 

 the median line from which no visible scar will result. 



7. LIGATION OF THE PAROTID DUCT. 

 PLATE VIII. 



Objects. The destruction of the parotid gland in case of 

 fistula from wounds or abscesses. 



Instruments. Razor, convex scalpel, straight probe- 

 pointed scalpel, teiiaculiini forceps, ligation forceps, tenacula, 

 needle holder, probe, suture and dressing material. 



Technic. In case of salivary fistula insert a probe 

 through the fistula into the duct toward the gland and with 

 a sharp scalpel la)* the parotid duct free for a distance of 

 from i to 2 cm. on the glandular side of the fistulous open- 

 ing. If the fistula has its location on the side of the cheek, 

 cast the horse and shave and disinfect the region on the 

 inferior maxilla where the artery, vein and parotid duct 

 turn around its inferior border. When the operator glides 

 his finger over the vascular region from before backward 



