OPERATIONS ON THE TONGUE. 363 



and dissection of the skin. The incision is made length-wise, from 

 the base of the ear down to the middle of the external face of the 

 gland, that is, as far as below the glosso-facial vein, and involving 

 the skin and the parotido-auricularis muscle, the dissection of the 

 skin being made a little beyond the borders and extremities of 

 the skin. The dissection of the gland forms the second step, and 

 must be as complete as possible. There are some parts where 

 the gland is difficult to isolate, especially at the base of the ear, 

 at its masseterine adhesions near the sub-zygomatic blood vessels 

 and nerves, but at these points some little glandular granulations 

 may be left. In this dissection the use of the fingers or of the 

 dull end of the handle of a dissecting scalpel is recommended in 

 order to avoid the blood vessels and nerves which are so intimately 

 connected with the organ. 



Beginning with the ligation and section of the posterior auric- 

 ular vein, the anterior border of the gland is isolated from above 

 downward, carefuUy avoiding the sub-zygomatic blood vessels 

 and nerves, after which the jugular vein is isolated in the whole 

 extent of its parotid course, and the gland divided into two por- 

 tions, one above, the other below the vein. The dissection of the 

 upper portion is made from below upward, avoiding first, four ar- 

 terial divisions, including the external carotid, the temporal trunk, 

 the internal maxillary, and the posterior auricular ; second, the 

 superficial temporal and the facial nerves ; and third, the guttural 

 pouch, which is intimately adherent to the internal face of the 

 gland above. The smaller arterial branches that are divided are 

 ligated or twisted. The lower portion is then carefully dissected 

 from above downward. The dressing of the wound, which is the 

 third step, is performed according to the process of Brogniez. 



Maxillae Y Adenotomy. 



We find but a single description of this operation, which is by 

 Director Degives in his Manuel de Medecine Operatoire Vettri- 

 naire. Eecommending it only as the last treatment in the re- 

 fractory fistula of Warthon's duct, he first divides the skdn and 

 the cutaneous muscle against the inferior border of the gland, 

 parallel to the glosso-facial vein, and makes an incision about four 

 inches long, which brings him to the loose and abundant cellular 

 tissue which surrounds the gland. The dissection is made with 



