PAROTITIS. 399 



There is 110 anatomical connexion between the parotid and 

 the testis or the ovary, and therefore metastatic inflammations in 

 these organs must be dependent rather upon a general infection. 



Parotitis, if not of the specific variety, may be induced by the 

 extension of septic organisms from the mouth along the duct to 

 the parenchyma of the gland. This may happen particularly 

 in enteric fever, and during convalescence from laparotomy, 

 especially where there is neglect of the proper care to keep the 

 teeth, gums, and tongue clean. 



Suppuration within the capsule of the gland is not uncommon. 

 The pus formed will track in the line of least resistance. Most 

 usually the line followed is forwards on to the cheek, backwards 

 and upwards through the cartilaginous portion of the external 

 auditory meatus, or inwards towards the pharynx, where there 

 may sometimes result a retropharyngeal abscess. This latter 

 situation is probably gained by the weak spot in the capsule in 

 the space between the anterior aspect of the styloid process and 

 the posterior border of the external pterygoid. For the same 

 reason, a collection of pus primarily originating in the retro- 

 pharyngeal tissues may find an exit through the substance of 

 the parotid. A parotid abscess may also advance into the 

 temporal fossa, into the tissues of the neck, or into the temporo- 

 mandibular joint cavity. 



In opening a parotid abscess, care must be taken not to wound 

 the structures contained within it. If an incision is made 

 directly into the abscess cavity, it should be so planned as to lie 

 nearly horizontally, and as low down as possible, so as to avoid 

 injury to the facial nerve or the parotid duct. Such an abscess 

 may be conveniently and safely opened by cutting on to the cap- 

 sule of the gland by an oblique incision, downwards and forwards, 

 and then opening into the abscess cavity by thrusting a director 

 onwards into it, and subsequently enlarging the opening by a 

 pair of sinus forceps. 



Parotid Tumours. Certain peculiar innocent growths are 

 found in connexion with the parotid, these tumours being 

 mixed in character, one component frequently being cartilage. 



