Atypical Forms 377 



nasal cavities may also extend to Highmore's cavity, and lead 

 to necrosis of the bony walls, and to cerebral meningitis (Nagy). 

 This may also develop by the suppnrating process progressing 

 along the nerve trunks into the cranial cavity (Augustin). The 

 abscess may also burst into the vertebral canal, whereupon 

 paralysis of the fore parts develops suddenly; with this SAanp- 

 toms of general spinal meningitis become rapidly associated 

 (Frolmer). 



An affection of the subparotid lymph glands results also 

 in marked swelling of one or both of the lower regions, but the 

 abscesses burst either into the laryngeal cavity or the pus sinks 

 downwards along the jugular groove until it finally finds its way 

 out in the middle of the neck or immediately anterior to the 

 entrance into the thorax. The inflammatory process may fur- 

 ther extend to one or both guttural pouches, which in such 

 cases become filled with pus, and the swelling thus produced 

 may reach the size of a child's head (in such cases a marked 

 dyspnea is always present). In rare cases the subparotid ab- 

 scesses burst into the guttural pouches, from which the pus 

 is discharged by the nose through the existing openings of 

 communication ; a portion however may remain in the guttural 

 pouch and change into a caseous, or later a mortar-like mass. 



If the abscess develops in the deeper layers of the laryngeal 

 region, directly under the floor of the buccal cavity, painful, 

 hard, later fluctuating swellings develop in the vicinity of the 

 frenum of the tongue, by which the veins and lymph vessels 

 of this region are compressed, and a serous infiltration of the 

 tongue results. This organ is then considerably enlarged, and 

 the tip protrudes between the teeth, while saliva flows profusely 

 from the mouth. The abscess usually opens into the l)uccal 

 cavity, whereupon the swelling of the surrounding parts and 

 the tongue diminishes promptly, and the abscess cavity rapidly 

 fills with granulation tissue. 



The affection of the submaxillary haiiph glands is some- 

 times associated with an inflammation of the superficial lymph 

 vessels of the head. In such cases the lymph vessels leading 

 from the eyes, cheeks, nose and lips swell to painful cords, 

 the thickness of a pencil, while the surrounding connective 

 tissue appears diffusely infiltrated. Later small nodules ap- 

 pear along the lymph vessels, which develop into abscesses. 

 At the same time the swelling of the surrounding tissues reaches 

 a very high degree, and the nostrils, cheeks and lips become 

 greatly thickened (formerly known as '' benign farcy"). There 

 may also be associated a diffuse purulent inflammation of the 

 subcutaneous connective tissue of the head and neck. In such 

 cases the affected parts of the body are greatly deformed, at 

 the same time high fever is present, and the respiration be- 

 cause of the swelling around the nasal openings is very difficult. 

 If the inflammatory process reaches such a high degree it almost 

 invariably results in fatal septicemia or pyemia. 



