THE FACE. 



from Meckel's ganglion, to emerge on the roof of the mouth at the posterior palatine 

 foramen. It causes free hemorrhage in operating on cleft palate. 



The Vidian and pterygopalatine branches supply mostly the roof of the pharynx; 

 they bleed when adenoids are removed. The descending and sphenopalatine sup- 

 ply the upper part of the tonsil with blood and may give rise to serious hemorrhage 

 in the removal of the tonsils. In operating on Meckel's ganglion, bleeding from 

 these vessels is free. The nasopalatine runs forward in the nose in the groove on 

 the vomer. It is often the cause of serious nasal hemorrhages in operations on the 

 septum. In removal of the upper jaw, bleeding occurs from many of the branches 

 of the internal maxillary, but it is hardly so free as might be expected, especially if 

 the external carotid has been previously ligated. 



PAROTID GLAND. 



The parotid gland lies on the cheek, behind the jaw and below the ear. The 

 limits (Fig. 60) of the gland are important because suppuration may occur in any por- 

 tion of its structure. Its extent is as follows : above to the zygoma, lying below its 



Superficial temporal artery 

 Transverse facial artery 

 Parotid duct 



Facial nerve 



Parotid gland 



Auricularis 

 magnus nerve 



External 

 jugular vein 



Submaxillary gland 



Facial artery and vein 

 FIG. 60. Parotid gland and structures of the side of the face. 



posterior two-thirds; posteriorly, to the external auditory canal, the mastoid process, 

 and digastric and sternomastoid muscles ; below to a line joining the angle of the jaw 

 and mastoid process ; and in front about half the width of the masseter muscle. 

 This latter is, however, quite variable. 



The parotid duct, also called Stensori ' s dzict, leaves the upper anterior portion 

 of the gland about a centimetre below the zygoma and runs on a line joining the 

 lower edge of the cartilaginous portion of the ear with the middle of the upper lip. 

 It opens on a papilla on the inside of the cheek opposite the second upper molar 

 tooth. This papilla can readily be seen and a fine probe can be inserted from the 

 mouth into the duct; thus the presence of a calculus may be detected. In operating 

 on the cheek the line of this duct must be borne in mind, as wounding it may cause 

 a salivary fistula. Wounds of the lobules of the gland are not nearly so liable to 

 result in fistula as those of the duct itself. 



