Chap, vii.i THE PAROTID REGION. 91 



across the gland, in a direction forwards and a 

 little downwards from the spot where the anterior 

 border of the mastoid process meets the ear. The 

 nerve is not quite so intimately bound up in the gland 

 as is the carotid artery, and in rapidly-growing 

 tumours of the gland facial paralysis from pressure 

 upon this nerve is not uncommon. 



It follows, from these and other relations of the 

 parotid, that its entire removal as a surgical procedure 

 is an anatomical impossibility. In opening a parotid 

 abscess, a- cut is usually made over the angle of the 

 jaw, and a director pushed upwards into the substance 

 of the gland, after the plan advised by Hilton. The 

 gland is separated by a mere layer of fascia from the 

 internal carotid artery, the internal jugular vein, the 

 vagus, glosso-pharyngeal, and hypoglossal nerves (Fig. 

 13). Thus, in stabs in the parotid region it may be 

 difficult at first to tell whether the internal or the 

 external carotid is wounded. It has been suggested 

 that the cerebral hypersemia, sometimes noticed in 

 severe parotitis (mumps), may be due to the pressure 

 of the enlarged gland upon the internal jugular vein, 

 with which it is in the closest contact. 



Many lymphatic glands are placed upon the sur- 

 face and in the substance of the parotid gland. They 

 receive lymph from the frontal and parietal regions of 

 the scalp, from the orbit, the posterior part of the 

 nasal fossae, the upper jaw, and the hinder and upper 

 part of the pharynx. When enlarged, these glands 

 may form one species of " parotid tumour." 



Stenson's duct is about two and a half inches 

 long, and has a diameter of one - eighth of an 

 inch, its orifice being the narrowest part. At the 

 anterior border of the masseter muscle the duct 

 bends suddenly inwards to pierce the buccinator 

 muscle. The bend is so abrupt that the buccal 

 segment of the duct may be almost at right angles 



