SYMPTOMS. — In the acute form the gland rapidly swells. The temperature becomes raised to 103° or 104°. The whole face becomes enlarged, when both glands are involved, and the lids edema tons. The pain is sometimes very severe, owing to the tense capsule with which the gland is surrounded. Pus-formation promptly follows in the majority of cases, and the pus may burrow in various direc tions,—the auditory meatus, the thoracic cellular tissue, the retropharyngeal tis sues, the maxillary joints, etc.,—and cause serious lesions if not promptly evacuated by incision.
In the chronic form—which may re sult from mumps, neighboring inflam matory processes, syphilis, the excessive use of mercury, etc.—the gland is also enlarged, but less painful, and may re main so several years.
TREATMENT.—As soon as pus is de tected an incision following the course of the facial nerve, or where the abscess seems to "point" (following, if possible, any crease the face may show, to avoid disfigurement) should be practiced. The incision must be sufficiently free to thor oughly evacuate the abscess. Anaesthe sia should be employed if possible, to insure operative thoroughness. The medical treatment is that indicated for mumps.
Salivary Calculus. — Salivary concre tions of various sizes sometimes form in the parotid gland and its duct,—Sten sen's,—causing inflammation of the or gan, retention of saliva, and enlargement of the organ. The majority of calculi, however, are found in Wharton's duct: the duct of the maxillary gland. Foreign bodies—which, as shown by Desmartin, frequently enter Wharton's duct—often act as nuclei. Blebs and Waldeyer con tend that masses of micro-organisms are the most common causes of salivary cal culi, the phosphates and carbonates of lime, magnesia, soda, etc., being deposited around them. The stones may become as large as eggs, and multiple, and are oc casionally facetted. In some cases the inflammatory phenomena proceed to ab scess-formation, and, spontaneous rupt ure taking place, a salivary fistula is formed. In the case of Stensen's duct the opening is opposite the second molar of the upper jaw. Wharton's duct opens beneath the tongue under the frmnum.
Both openings can be penetrated with a probe, or a fine needle may be inserted into the mass and its contents thus recog nized.
One hundred and ninety-six cases of salivary calculus have been reported. This condition is at times mistaken for a dermoid, lipoma, ranula, or malignant tumor. Lindemann (Dent. med. \Voch., No. 41, p. GS3, '95).
—It is sometimes possible to remove a small calculus through the canal; but, as a rule, it is necessary to thoroughly anesthetize the part with cocaine and to remove the mass by an incision through the oral tissues.
The following procedure is recom mended for the cure of salivary fistula connected with Stensen's duct: Evert ing the cheek with the thumb on the inside and the finger on the outside, a curved needle armed with a silk thread is carried beneath and around the duct, a short distance posterior to where it opens into the mouth, both the entrance and the exit of the needle being on the mucous surface of the mouth, and not deep enough to reach the integument of the cheek. The needle is now detached from the thread, and the ends of the lat ter, after being tied together, are brought out of the corner of the mouth and se cured to the outside of the face by a strap of adhesive plaster. As the thread ulcerates its way through the included tissues, the duct is separated from the cheek, causing the saliva to flow into the mouth, and is quickly followed by closure of the fistulous orifice on the cheek. Agnew (University Med. Mag., July, '91).
Tumors of the Salivary Glands. CYSTS.—Cystic dilatation of the parotid and maxillary glands or of their ducts is occasionally observed, as a result of a superficial inflammatory process or of cicatricial stenosis of the orifices. In a case noted by Stubenrauch the growth— a parotid cyst—was found studded with tubercular nodules. Stensen's duct may become inflated with air through forcible air-pressure—such as that accompanying the playing of wind-instruments, glass blowing, etc.—and simulate a cyst.
In many of these cases it is necessary to remove the sac-wall after evacuating the contents by incision.