THE FACE. 



53 



Lymphatic nodes are found both on the gland and in its substance. These may 

 be involved in general disease of the cervical lymphatics. 



Affections of the Parotid Gland. The duct may be affected with calculus, 

 as already mentioned. As the opening of the duct at the papilla is smaller than the 

 lumen of the canal farther back, calculi are apt to lodge close to the anterior extrem- 

 ity. They are, therefore, readily felt and removed by incision on the inside of the 

 mouth. The gland proper is subject to inflammations and tumors. 



Simple parotiditis or mumps really is an infectious inflammation, nevertheless, it 

 rarely suppurates. Suppurative parotiditis may occur from infected wounds or arise 

 in the course of the eruptive fevers, etc. In inflammation of the gland, pain and 

 swelling are important symptoms. The pain, which is considerable, is not due so 

 much to the so-called dense parotid fascia covering the gland, for this is only 

 moderately thick, as it is to the fact that the gland is of a racemose type and the 



Transverse 

 facial artery 



Branches of 

 facial nerve 



/Temporal artery 



Parotid duct 



Auricularis 

 magnus nerve 



'Jugular vein 



External carotid 

 artery 



FIG. 62. Structures in relation with the parotid gland. 



fibrous septa between the lobules are abundant and prevent free expansion of the 

 contained lobules. Expansion is also hindered by the peculiar location of the various 

 parts of the gland. Swelling of the glenoid lobe produces pain in the ear and also in 

 the temporomaxillary articulation. Swelling of the carotid and pterygoid lobes 

 causes pain and fulness in the throat. Opening the lower jaw reduces the space 

 posterior to it in which the gland lies and pinches it against the bony meatus and 

 mastoid process, so that it is impossible to open the jaw widely. 



If suppuration occurs it is liable to progress from one lobule to another; when 

 this is the case comparatively small abscesses may appear in different parts of the 

 gland with unaffected tissue between them. As an abscess heals in one lobule, sup- 

 puration is apt to occur in another, consequently the disease may persist for a long 

 time. More rarely in the course of or following infectious diseases, particularly in 

 debilitated patients, considerable portions of the gland may slough. This form is apt 

 to be fatal. If the suppurating focus is confined to lobules which are deeply placed, 

 the diagnosis may be obscure because it is difficult to localize the affected spot. If, 

 however, it is near the surface of the gland, the pus does not tend to extend sideways, 

 the fibrous septa prevent this, but it tends to work its way up and perforate the skin. 

 If the glenoid lobe is affected, the pus 'may find an exit through the external auditory 

 meatus or even involve the temporomaxillary joint. If the carotid or pterygoid lobes 



