ACUTE PAROTIDITIS. 



185 



the parotid region between the lower jaw and the upper extremity of 

 the neck. The lesion is usually unilateral, but occasionally bilateral. 



Parotiditis may terminate in resolution, suppuration, or necrosis. 

 The suppuration may either be simply subcutaneous and extra-glan- 

 dular, or may involve a portion of the salivary gland and of the parotid 

 lymphatic gland in addition. 



Necrosis is exceptional, though Moussu saw^ double and total gangrene 

 of both parotids, complicated with septicaemia, in the animal, of which a 

 sketch is given herewith. 



If the disease is due to violent injury by a foreign body, traces of a 

 wound may be found, but it 

 is often useless to search for 

 these, even w^hen the parts 

 have been pricked with a 

 sharp goad. When the in- 

 flammation has resulted from 

 ascending infection of the 

 salivary ducts, exaggerated 

 sensibility may sometimes 

 be detected throughout the 

 whole length of Stenon's 

 duct, particularly at the point 

 where the duct crosses the 

 jaw. There is always marked 

 difficulty in moving the head, 

 particularly towards the side, 

 and sometimes in a vertical 

 plane. The head is extended 

 on the neck, and is held stiffly 

 in such a w^ay as to suggest 



the possibility of tetanus. Some observers have described as an impor- 

 tant symptom marked swelling of the orifice of Stenon's duct. It is cer- 

 tainly difficult to detect, and furthermore is of no great significance. 



Diagnosis. Although diagnosis is easy, it is a difficult matter to 

 detect the point of origin of the disease. The salivation and difficulty 

 in swallowing might seem to suggest pharyngitis, a condition which 

 sometimes exists simultaneously. The distinction betw^een this disease 

 and the forms of chronic parotiditis, or tumour formation in the parotid 

 (due to actinomycosis, lymphadenoma, melanoma), is also easy, on ac- 

 count of the slow development of the last-named conditions. The only 

 condition liable to be confused with that under consideration is abscess 

 of the sub-parotid gland. 



Prognosis. The gravity of the disease varies greatly. When 



i 



Fig. 63. — Acute parotiditis. 



