Submaxillary Adenitis. Maxilitis 45 



maxillary salivary gland swollen and tender. This may be de- 

 tected in the intermaxillary space, but is especially noticeable 

 along the lower and lateral aspect of the tongue. If the mouth 

 is opened and the tongue drawn to one side a mass of food may 

 be found to one side of the frsenum lingui, and beneath this the 

 projecting, red inflamed papilla which covers the Whartonian 

 orifice. Extending backward from this the duct is felt as a 

 thickened cord, and when this is compressed a purulent liquid 

 flows from the orifice. The mouth becomes offensively foetid. 



The tendency is to suppuration, and if this is determined in 

 the Whartonian duct only, by the presence of foreign bodies, cal- 

 culi, or microbes it may recover in connection with an abundant 

 mucopurulent discharge and a free secretion of saliva. If it 

 occurs in the gland tissue itself by reason of the penetration of 

 the microbes into the follicles, the tendency is to circumscribed 

 abscess, which may point and burst by the side of the root of the 

 tongue, or externally in the intermaxillary space. In the first 

 case the tongue is displaced upward and to the other side of the 

 mouth by the hard, firm swelling, which is felt on one side be- 

 neath the back part of that organ, and later there is the wound, 

 the profuse mucopurulent discharge, and intense fcetor. If on 

 the other hand the abscess forms nearer the skin, there is the 

 firm, painful intermaxillary swelling, which finally points and 

 bursts- discharging pus of a septic odor. It may be mixed with 

 the foreign bodies that have penetrated through the canal, with 

 morsels of necrosed gland tissue and with blood. 



Treatment. The first consideration is to extract any foreign 

 bodies which have lodged in the duct causing irritation and in- 

 fection. The finger passed along the line of the swollen duct 

 may detect the seat of such foreign body by the extra swelling, 

 and may extract it by manipulation from behind forward. This 

 may sometimes be assisted by the introduction of a grooved 

 director as far as the foreign body, or even by a catheter which 

 can be made to distend the canal in front of the object and open 

 the way for its easier passage. In case of failure and in all cases 

 of the introduction of small bodies like vegetable awns or spikes 

 pilocarpin may be given to cause an excessive secretion and thus 

 as it were purge the canal of its offensive contents. Incision 

 of the canal over the foreign bod)' is the dernier resort. 



