MORBID ANATOMY. - The parotid gland is far more frequently the subject of disease than either the submaxillary or sublingual. The idiopathic inflammation of these glands is known under the name of Cynanche parotidea, vulgarly translated " mumps." The submaxil lary is occasionally, and the sublingual but rarely implicated. The surrounding soft parts, particularly the lymphatic glands, participate in the inflammation, tending greatly to increase the swelling. On account of the intimate relation of the glands with the jaw, consider able pain and inconvenience form a prominent symptom. The saliva is at first increased, and subsequently diminished in quantity. Suppuration very rarely occurs. Secondary inflammation takes place as an occasional com plication of the different forms of fever. In eighteen cases of typhoid Louis observed one in which the parotid was implicated. The man died on the thirty-ninth day of the attack ; and nine days prior to death pain supervened in the parotid glands, which were found after death to be twice their ordinary volume, and studded throughout with small purulent deposits.
The chief point of interest, however, to the surgeon and anatomist, in connection with inflammation of the parotid, is the formation of' abscess in the region of the gland. This may either take place in the subcutaneous cellular tissue superficial to the parotid fascia, or in the substance of the gland beneath that fascia. It generally occurs, in the one form or the other, in connection with phlegmonous erysipelas of the face and neck. Abscesses forming in the latter situation demand the prompt attention of the surgeon, inasmuch as they are attended with the most severe con stitutional symptoms, which are only relieved by a free incision through the dense fibrous envelope of the gland : unless thus treated, the matter either makes its way through the external auditory canal, by passing between its bony and cartilaginous divisions, or, after the most severe symptoms, bursts externally in the parotid region. It may even extend deeply into the neck as far as the trachea, and terminate by effusion into the chest and —death. Independent of this extensive bur rowing, matter pent up beneath the parotid fascia may exert a most injurious influence by compression of tbe larger vessels of the neck, the structure of the gland itself, and the facial nerve. Examples, in fact, are on record of almost complete destruction of the gland itself, and incurable facial paralysis, from neglect of incising the parotid fascia at an early period of the formation of pus beneath it.
In inflammation of the salivary glands, whether primary or secondary, the areolar tissue of the gland is most usually affected ; in a few instances, however, the true structure of the gland is implicated. Berard* relates a remarkable instance of this kind, in which both the areolar and glandular tissue were affected. When the parotid was pressed, pus flowed into the mouth from Steno's duct.
Abscesses connected with disease of the ear now and then make their way into the sub stance of the parotid gland.
Encysted tumours are occasionally observed in the body of the parotid, and in all pro bability are more in connection with the lymphatic glands than the gland itself, except in those cases where they arise front isolated collections of saliva, owing to obstruction in some part of the excretory canal. The latter
formations are, however, but rarely met with, and, when so, occur usually in the track of Steno's duct.
The parotid and submaxillary undergo also fibrous and carcinomatous degeneration. The latter affection, as a purely idiopathic change, is extrernely rare ; and, although the records of surgery afford ample illustration of such in the parotid, according to the assertions of the authors of individual cases, the evidence in some must be received with considerable reserve. Carcinoma originating in the lym phatic glands, superficially to or beneath the parotid fascia, or, lastly, in the paren chyma of the gland itself, has been, in fact, indiscriminately described as carcinoma of the parotid gland. This subject has been minutely inquired into by Berard, as also the extir pation of the gland in a great number of the cases on record. He concludes his observa tions, by remarking that scirrh us of the parotid generally calls for the extirpation of the parts affected ; and supports this conclusion by ob serving, that relapses alter the operation are comparatively rare. This inference is at variance with the opinion of many practical surgeons ; and it would require a much more extensive and impartial series of statistics than we at present possess to arrive at a definite conclusion on the subject. No greater difficulty exists than to obtain the subsequent history of apparently successful cases in sur gery, and that of those in which the parotid has been extirpated forms no exception to the remark. In the case related by Mr. Luke and in which there is every thing to show that the parotid was entirely extirpated, the disease returned at the end of a year, and terminated fatally. In Mr. Solly's case*, in which the ascending ramus of the jaw was removed, in order to extirpate the gland as completely ;is possible, the disease, instead of being confined to the parotid gland, was found, a few months afterwards, by the death of the patient, to have proceeded from the brain. Other cases, again, have been described as carcinomatous affections of the parotid, but in yvhith their details by no means indicate that such was their nature. The case related by Larrey, for example, and which he considered to be one of carcinoma, will appear, we think, on a careful perusal, to have been nothing more than a struinous affection of the lymphatic in the substance of the gland, or possibly of the gland itself, " which had degenerated into a dense yellow lardaceous substance."t A remarkable case of hypertrophy of the parotid is related by Tenon. It had the form of a tumour, of the size of the fist, ex tending from the ear to the angle of the lips ; it was soft, white, indolent and movable, some large vessels here and there ramifying on the surface. The arteries, on the death of the child, were found considerably en larged, which circumstance, in all probability, accounted for the condition of the gland.