FISTULA OF THE PAROTID DUCT 261 



Well - scalded bran and oatmeal, with pulped roots, and a liberal 

 allowance of linseed gruel, will form a suitable diet, and the addition of 

 iron and vegetable tonics may also be required to uphold the strength 

 and hasten recovery. Careful search should be made from time to time 

 for the formation of abscess, and so soon as it is found to " point ", i.e. 

 fluctuate under pressure of the finger, it must be freely opened and the 

 matter allowed to escape. All that is now required is to keep the wound 

 clean by sponging it with antiseptic solution, and protecting it by a pad 

 of cotton-wool under a bandage. 



If after the wound is healed the gland still remains enlarged, a 

 cantharides or iodine blister ought to be promptly applied and repeated 

 if necessary. 



FISTULA OF THE PAROTID DUCT 



The parotid duct, or duct of Stenson, is the vessel or canal by which 

 saliva is conveyed from the salivary gland into the mouth. On leaving the 

 gland the parotid duct (fig. 92, p. 259) passes along the inner surface of 

 the lower jaw, and then winds round its lower border in front of the great 

 muscle of the cheek in company with the inferior maxillary artery and 

 vein, and finally opens into the mouth opposite to the junction of the 

 second with the third molar tooth of the upper jaw. In its course round 

 the jaw-bone and along the side of the face it becomes exposed to injury, 

 and as the result of blows from the kicks of horses and other mishaps as 

 well as from the ulcerating effects of calculi (stones) which sometimes form 

 within it, an opening is made through its walls at the seat of injury by 

 which the saliva is allowed to escape instead of passing into the mouth. 

 The duct may be completely divided, as sometimes occurs from external 

 violence, in which case one portion of the vessel is separated from the other, 

 or it may only be punctured. Obviously the former condition is the more 

 serious of the two, since the divided ends draw away from each other and 

 are with difficulty brought together under the most favourable circum- 

 stances; and if allowed to remain apart for any length of time that portion 

 connected with the mouth closes up, owing partly to no saliva being able 

 to enter it, but more immediately as the result of inflammation excited in 

 it by the accident. Fistula of the parotid duct may also result from the 

 formation of an abscess in some part of its course giving rise to ulceration 

 of its walls. 



Symptoms.— The existence of this disease is known when a watery 

 fluid is found to discharge through an opening in the skin at or near the 

 lower border of the jaw (fig. 94). The quantity will depend a good deal 



