LfGATlON OF THE PAROTID DUCT. 



45 



move every portion of the ligament in the area indicated 

 and all calcareous deposits or diseased tissues. With I^uer's 

 forceps groove a channel about 2 cm. wide from behind to 

 before directly upon the median line through the occipital 

 protuberance to the depth of about 2 cm. making the bottom 

 as near as possible on a level with the wound in the soft 

 tissues as indicated by the dotted line, AA. Using I^uer's 

 forceps as a curette detach all vestiges of the neck ligament 

 from the base of the occiput and leave the bone bare and 

 smooth. If the L,uer or ronguer forceps are not available 

 the grooving of the occiput may be accomplished with a 

 strong curved bone gouge. Be careful to avoid penetrating 

 the cranial cavity or the occipito-atloid articulation. Con- 

 trol the hemorrhage, cleanse and disinfect the wound, pack 

 with iodoform gauze and suture for its entire length except 

 the anterior part, where the tampon should slightly pro- 

 trude, and dust the margin of the wound with iodoform 

 and tannin. Remove the tampon after forty-eight hours 

 and dress artiseptically daily. The sutures may or may 

 not be removed according to conditions. In carrying out 

 this operation our chief aim should be to remove all diseased 

 parts, to afford perfect drainage anteriorly, to secure and 

 maintain antisepsis, and to keep the wound directly on the 

 median line from which no visible sca:r will result. 



7. IvIGATION OF THE PAROTID DUCT. 

 Pl,ATE IX. 



Objects. The destruction of the parotid gland in case of 

 fistula from wounds or abscesses. 



Instruments. Razor, convex scalpel, straight probe- 

 pointed scalpel, tenaculum forceps, ligation forceps, tenacula 

 needle holder, probe, suture and dressing material. 



Technic. In case of salivary fistula insert a probe 

 through it into the duct toward the gland and with 



