LIGATION OF THE PAROTID DUCT. 6 1 



8. LIGATION OF THE PAROTID DUCT. 

 Plate XII. 



Objects. The destruction of the parotid gland in case of 

 fistula from wounds or abscesses. 



Instruments. Razor, convex scalpel, straight probe- 

 pointed scalpel, tenaculum forceps, ligation forceps, tenacula, 

 needle holder, probe, suture and dressing material. 



Technic. In case of salivar}' fistula insert a probe 

 toward the gland through the fistula into the duct and with 

 a sharp scalpel lay the duct free for a distance of from i to 

 2 cm. on the glandular side of the fistulous opening. If the 

 fistula has its location on the side of the cheek, cast the 

 horse and shave and disinfect the region on the inferior 

 maxilla where the artery, vein and parotid duct turn around 

 its inferior border. When the operator glides his finger 

 over the vascular region forward and backward there is felt 

 a resistant cord, the pulsating external maxillary artery 

 about 3 mm. in diameter. Between this and the oral border 

 of the masseter muscle make an incision about 4 cm. long 

 parallel to the artery through the skin and skin muscle. 

 Pick up the loose connective tissue with a pair of forceps 

 and excise it. Immediately behind the external maxillary 

 artery, a, Figs, i and 2, Plate XII, is the external maxil- 

 lary vein, V, and behind this and immediately at the border 

 of the masseter muscle lies the parotid duct, si. 



In case of salivary calculi which cannot be removed 

 through the mouth or of cystic dilation of the parotid duct, 

 make the cutaneous incision at the affected point, open the 

 canal, and after the removal of the calculus, etc., close the 

 duct wound by means of intestinal sutures in such a way 

 that the external surfaces of the lips of the wound in the 

 wall of the duct are brought in contact, or ligate the duct 

 on the proximal side of the point of operation and destroy 

 the gland. 



