ro6 SURGICAL APPLIED ANATOMY, rchap. vn. 



abscess directly outwards through the skin. The 

 abscess often advances upwards to the temporal, or 

 zygotnatic fossje, in the direction of least resistance, 

 although progress in that line is resisted by gravity. 

 It frequently makes its way towards the buccal 

 cavity or pharynx, or it may break through the 

 lower limits of the fascia and reach the neck. It 

 must be borne in mind that the gland is in direct 

 contact with the cartilaginous meatus, with the ramus 

 of the jaw and other bony parts, and is closely 

 related with the temporo-maxillary joint. Thus, a 

 parotid abscess has burst into the nieatus, has led to 

 periostitis of the bones adjacent to it, and has incited 

 inflammation in the joint of the lower jaw. 



In several cases reported by Virchow the pus 

 appears to have found its way into the skull along 

 branches of the fifth nerve, for the environs of the 

 Gasserian ganglion were found infiltrated with pus. 

 The auriculo-temporal and great auricular nerves sup- 

 ply the gland with sensation, and the presence of these 

 nerves, together with the unyielding character of the 

 parotid fascia, serve to explain the great pain felt in 

 rapidly growing tumours and acute inflammation of the 

 gland. The pain is often very distinctly referred along 

 the course of the auriculo-temporal nerve. Thus, a 

 patient with a parotid growth, recently under my care, 

 had pain in those parts of the pinna and temple supplied 

 by the nerve, pain deep in the meatus, at a spot that 

 would correspond to the entrance of the meatus branch 

 of the nerve, and pain in the joint of the lower jaw, 

 which is supplied by the auriculo-temporal. 



The most, important structures in the gland are 

 the external carotid artery, with its two terminal 

 branches, and the facial nerve. The artery, as 

 Tillax has pointed out, is behind the ramus of the 

 jaw, as high up as the junction of the inferior with 

 the middle third of its posterior border. It then 



