354 
LESIONS OF THE PAROTID DUCT. 
establish the course of the saliva, and conduct it into the mouth, 
and at the same time to obtain a cicatrization of the fistulous 
opening. In the procedure of Deroy, after the fall of the scab, 
Duphenix introduced the quill part of a feather; Monro a seton; 
and Leroy a leaden wire. Other surgeons, as Lotta, Larigenbeck, 
&c., recommend certain proceedings, so difficult, if not impossible 
of execution, and so little thought of among medical men, that it 
will be unnecessary to enter into any description of them. 
M. Deguise had a very ingenious mode of proceeding, but one 
which must, we should think, be very painful to the patient. He, 
like Duphenix, made use of the trocar, which he carried to the 
bottom of the fistula, directing it obliquely from the top down- 
wards, piercing the cheek in that direction, and, as much as pos- 
sible, following the direction of the canal. The puncture being 
made, the instrument is withdrawn, and a leaden wire is introduced 
into the tube, and held in the mouth with two fingers. That being 
done, the tube is removed, recourse is again had to the trocar, 
which is again carried to the bottom of the wound, and the cheek 
is a second time pierced in another direction. By means of the 
tube from which the trocar has been removed a waxed thread is 
passed in, which is intended to draw into the mouth the leaden 
wire remaining on the outside, the tube having been first removed. 
The wire thus placed forms a curve, embracing the soft parts at 
the bottom of the fistula. The free extremities are re-united in 
the interior of the mouth : afterwards, when the external wound 
has cicatrized, the wire is withdrawn ; and sometimes it is left to fall 
out of itself during the interval that the two openings are becoming 
merged into one. 
D. — The fourth method proposes to atrophize the gland, by 
establishing immediate pressure upon it ; but as this proceeding 
appeared to most surgeons difficult of execution, and not to be 
depended upon, Zang and Yiborg have advised that a ligature 
should be placed round the canal, between the gland and the 
fistula. 
This is a cursory view of the chief means recommended and 
practised for the purpose of curing fistulse of the parotid duct. 
Were we to form an estimate of the value of each particular one — 
a task which does not come within the nature of our present work — 
we should find each of them to be attended with advantages and 
disadvantages, according to the divers aspects under which these 
affections present themselves. But, as general rules, the results 
of the preceding considerations will be as follow : — 
1st, That the modes of treatment are, in the great majority of 
cases, exceedingly long. 
2d. That the surgical operations required by them are delicate, 
