LIGATION OF THE PAROTID DUCT 45 



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 vas- 

 cular region forward and backward, there is felt a resistant 

 cord, the pulsating external maxillary artery about 3 mm. 

 in diameter. Just behind this (towards the oral border of 

 the masseter muscle) lies the external maxillary vein and 

 lying more deeply between the vein and border of the 

 masseter, is the parotid, or Steno's duct, covered by dense 

 connective tissue. Make an incision about 4 cm. long di- 

 rectly over the duct parallel to the artery through the skin 

 and skin muscle. Pick up the connective tissue with a pair 

 of forceps and excise it, laying the duct bare. Care is to be 

 taken while manipulating the duct, not to prick the con- 

 tiguous vein and cause annoying hemorrhage. 



When a salivary calculus exists which cannot be removed 

 through the mouth, or there is a cystic dilation of the parotid 

 duct, make the cutaneous incision at the affected point. 

 After opening the canal, and removing the calculus, etc., 

 close the duct wound by means of intestinal sutures in such 

 a way that the external surface 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 

 thereby destroy the gland. 



Ligation of the duct is accomplished by passing a strong 

 silk thread beneath it by means of a curved aneurism needle, 

 carrying the ligature around the duct and tying with a sur- 

 geon's knot. This destroys the gland by damming back 

 the saliva until the pressure stops its function and causes 

 atrophy. Disinfect the wound and close the skin by means 

 of a continuous suture. 



