90 SURGICAL APPLIED ANA TOMY. [Chap. vn. 



parotid abscess has burst into the meatus, has led to 

 periostitis of the bones adjacent to it, and has incited 

 inflammation in the joint of the lower jaw. 



In several cases reported by Yirchow, the pus 

 appears to have found its way into the skull along 

 branches of the fifth nerve, for the environs of the 

 Gasserian ganglion were found infiltrated with pus. 

 The auriculo-temporal and great auricular nerves sup- 

 ply the gland with sensation, and the presence of these 

 nerves, together with the unyielding character of the 

 parotid fascia, serve to explain the great pain felt in 

 rapidly-growing tumours and acute inflammation of 

 the gland. The pain is often very distinctly referred 

 along the course of the auriculo-temporal nerve. Thus, 

 a patient with a parotid growth, recently under my 

 care, had pain in those parts of the pinna and temple 

 supplied by the nerve, pain deep in the meatus, at 

 a spot that would correspond to the entrance of the 

 meatus branch of the nerve, and pain in the joint of 

 the lower jaw, which is supplied by the auriculo- 

 temporal. 



The, most important, structures in the gland are 

 the external carotid artery, with its two terminal 

 branches, and the facial nerve. The artery, as 

 Tillaux has pointed out, is behind the ramus of the 

 jaw, as high up as the junction of the inferior with 

 the middle third of its posterior border. It then 

 enters the parotid gland, and, passing a little back- 

 wards and outwards, comes nearer to the surface, 

 and at the level of the condyle of the jaw breaks 

 into its two terminal branches. The artery, there- 

 fore, does not enter the gland at its inferior border, 

 and is not in actual relation with the parotid space 

 at its lowest part. The vessel, moreover, is not 

 parallel with the edge of the ramus, but passes 

 through the parotid gland with some obliquity. 



The facial nerve is represented by a line drawn 



