56 SURGICAL ANATOMY OF 



lids, and cheeks ; and the deepest, which accompany the 

 internal carotid, are the vessels of the temporal and 

 maxillary regions. The facial nerve, after it has passed 

 through the stylo-mastoid foramen, enters the posterior 

 and inferior portion of the parotid, and thence spreads 

 out into several large plexiform branches (pes anserinus), 

 after which it ramifies amongst the muscles of the face. 

 The auriculo-temporal branch of the inferior maxillary 

 nerve also enters the gland after having passed behind 

 the neck of the jaw, and forms inosculations with the 

 facial. The auriculo-parotidean branch of the cervical 

 plexus enters the gland anteriorly and inferiorly, inos- 

 culating with the preceding. 



The existence of the tough fibrous investment which 

 incloses the gland almost entirely and binds it so tightly 

 in its place, accounts for the intense pain in inflamma- 

 tion, as in parotitis, or abscess. Wounds, or the results 

 of abscess in the substance of the gland, may give rise 

 to salivary fistulce, which are frequently very trouble- 

 some to close; and in the removal of tumors connected 

 with it, or in its neighborhood, there is, of course, great 

 danger of severe hemorrhage, and of wounding the facial 

 nerve, thus causing paralysis of the facial muscles. The 

 surgical relations of the duct of the parotid have been 

 already considered (vide Face). The external carotid 

 may be compressed against the styloid process in the 

 adult, but it is impossible in the child, owing to the un- 

 developed state of that portion of the bone. 



SURGICAL ANATOMY OF THE PTERYGO-MAXIL-. 

 LAKY REGION. 



The surf ace markings of this region are the bony promi- 

 nences of the zygoma and lower jaw, and the contour of 



