1 8 The Parotid Gland 





the glandulu: concatenate. The nerves are derived from the 

 auricular, auriculo-temporal, the facial, and the sympathetic. 



The duct, stenson's, comes off from the anterior part of the gland, 

 and, crossing the masseter below the transverse facial artery, but above 

 the chief part of the facial nerve, pierces the buccinator opposite the 

 second upper molar. The duct consists of a strong fibrous coat with 

 a mucous lining covered with columnar epithelium. 



To mark out the course of the duct, a line must be drawn from the 

 lower part of the concha to the middle of the upper lip. When the 

 jaws are tightly closed the duct may be made out by running the 

 finger up and down the front of the masseter. 



In operations upon the cheek, care must be taken not to wound 

 the duct, as a salivary fistula may occur, which is a most troublesome 

 one to obliterate. Sometimes a small calculus blocks the duct, and a 

 dilatation then occurs upon the parotid side of the obstruction, the 

 cavity becoming distended at the smell or sight of food. It is often a 

 very difficult matter to extract the calculus from the dilated part of the 

 duct, as it may slip back towards the gland or into a pouch developed 

 behind the angle of the jaw, or even beneath the ramus. 



When malignant disease has invaded the parotid gland extirpation 

 is impracticable, and an attempt to accomplish it is likely to entail 

 profuse haemorrhage, facial paralysis and disappointment. 



A specific inflammation (iniunps) is apt to attack the gland ; the 

 swelling causes a bulging close below the jaw, and when it is sym- 

 metrical it renders the face very broad. The movements ^of mastica- 

 tion disturb the gland and cause pain. In rare cases facial paralysis 

 is caused by pressure on the portio dura, and more rarely still deafness 

 or abscess supervenes. In the latter case the pus might find its way 

 into the external auditory meatus. Mumps is distinguished from 

 cervical lymphatic enlargement by the fact that the chief swelling is 

 above the angle of the jaw. 



The submaxillary gland is placed in the submaxillary triangle 

 (p. 9) resting upon the mylo-hyoid, and covered by skin, superficial 

 fascia, platysma, and deep fascia, and by the overhanging border of the 

 jaw. The deep part of the gland turns round the free border of the mylo- 

 hyoid and rests on the hyo-glossus and stylo-glossus. Posteriorly, the 

 gland is separated from the parotid by the stylo-maxillary ligament, and, 

 anteriorly, from the sublingual by the mylo-hyoid. The hyo-glossus 

 separates the gland from the lingual artery (v. p. 27). The facial artery 

 runs through, and the vein over, the gland. 



Wharton's duct comes up from the deep part of the gland, passing 

 between the sublingual gland and the genio-hyo-glossus to open on 

 a conspicuous papilla at the side of the fraenum. The beginning of 

 the duct rests upon the hyo-glossus, between the gustatory and hypo- 

 glossal nerves. 



Supply. The arteries and veins are branches of the facial trunks. 



