Chap VIM THE FACE. 107 



enters tho parotid gland, and, passing a little back- 

 wards and outwards, comes nearer to the surface, 

 and at the level of the condyle of the jaw breaks 

 into its two terminal branches. The artery, there- 

 fore, does not enter the gland at its inferior border, 

 and is not in actual relation with the parotid space 

 at its lowest part. The vessel, moreover, is not 

 parallel with the edge of the ramus, but passes 

 through the parotid gland with some obliquity. 



The facial nerve is represented by a line drawn 

 across the gland, in a direction forwards and a 

 little downwards from the spot where the anterior 

 border of the mastoid process meets the ear. The 

 nerve is not quite so intimately bound up in the 

 gland as is the carotid artery, and in rapidly growing 

 tumours of the gland facial paralysis from pressure 

 upon this nerve is not uncommon. 



The nerve has been stretched close to its point of exit 

 from the stylo-mastoid foramen for the relief of facial 

 tic. It is best found at a spot about a quarter of an inch 

 in front of the centre of the anterior border of the 

 mastoid process. 



It follows, from the complex relations of the parotid, 

 that its entire removal as a surgical procedure is an 

 anatomical impossibility. In opening a parotid abscess 

 a cut is usually made over the angle of the jaw, and 

 a director pushed upwards into the substance of the 

 gland, after the plan advised by Hilton. The gland is 

 separated by a mere layer of fascia from the internal 

 carotid artery, the internal jugular vein, the vagus, 

 glosso pharyngeal, and hypoglossal nerves (Fig. 13). 

 Thus, in stabs in the parotid region it may be difficult 

 at first to tell whether the internal or the external 

 carotid is wounded. It has been suggested that the 

 cerebral hypersemia, sometimes noticed in severe paro- 

 titis (mumps), may be due to the pressure of the 

 enlarged gland upon the internal jugular vein. 



