Lines Of Incision For Abscess

The manner of opening a parotid abscess depends on its location and size. If it is desired to open an abscess anterior to a point 1.5 cm. or about half an inch in front of the ear, the structures to be avoided are the duct and facial nerve. The incisions are to be made parallel to the zygoma, and the duct is to be avoided by not cutting on a line joining the lower edge of the cartilage of the ear with the middle of the upper lip. The branches of the facial nerve lie deep and are to be avoided by making the incision parallel to their course and not extending it too deeply. After incising the skin, the deeper tissues may be separated by introducing a pointed pair of haemostatic forceps and operiing the blades. In operating in the region below the ear, the blood-vessels are to be avoided. To do this incise the skin longitudinally, not transversely, and open the deep parts carefully with the haemostatic forceps, as already described. Another method, when the abscess is farther forward, is to make a horizontal incision rather low down on the angle of the jaw and then introduce a grooved director or haemostatic forceps from below upward.

Tumors of the parotid gland are liable to be mixed in character, with a sarcomatous element. They are often fairly circumscribed and, particularly if they do not involve the parotid duct, can be removed comparatively readily. If they are malignant and large, complete removal is practically impossible. The possibility of parotid fistula and paralysis of the facial nerve following operation on this gland should always be borne in mind and explained to patients. The presence of facial paralysis is indicative of malignancy (see Fig. 63). The parotid lymph nodes on or beneath the capsule may become enlarged and inflamed and resemble true parotiditis. There is one node just below the zygoma and in front of the ear that is not infrequently enlarged in strumous children. This is apt to be involved when affections of the lids or scalp are present. In opening abscesses of these nodes there is little likelihood of injuring either the nerve or the duct, because the nodes are superficial. The transverse facial artery is usually too small to cause trouble. The possibility of its supplying the coronary arteries of the lips, as already described, in which case it would be very large, should be remembered.