Parotid gland

“ The stimuli for the reflex are numerous, and, it appears, are not the same for all of the glands. For instance, the submaxillary glands are said to secrete upon the presence of certain foods, acids in the mouth, the chewing of meats, etc. On the other hand, the stimulus for the parotid gland has been shown by Pavlow to be the presence of dry substances in the mouth. If no distinction is made between glands, it may be said that watery foods cause only a slight flow of saliva, while dry foods cause a large flow of saliva. ”

“ The gland which most commonly suffers is the parotid, although the submaxillary, the axillary, and even the inguinal, are occasionally involved. These glandular affections never take place but in formidable cases, and their occurrence sometimes changes at once the entire character of the disease, and destroys the slightest hope of recovery. ”

“ Any acrid drug, as pyrethrum, held in the mouth acts as a sialagogue externally by stimulating the excretory ducts of the salivary glands; and the siliqua hirsuta applied externally to the parotid gland, and even hard substances in the ear, are said to have the same effect. Mastich chewed in the mouth emulges the salivary glands. ”

“ Suppurative parotitis may be due to direct spread of infection from the mouth along the parotid duct, or to extension of suppurative processes from the temporo-mandibular joint, the jaw, or a lymph gland. It is liable to occur also in the course of any disease in which there is an infection of the blood with pyogenic bacteria, and has been met with in diphtheria, typhoid fever, scarlet fever, measles, and other eruptive fevers. ”

“ Idiopathic parotitis, parotitis epidemica, or mumps, as it is variously named, is an acute contagious inflammation of one or both parotid glands, which usually appears but once in a lifetime, and which, although by no means limited to children, is commonly met with between the second year and the age of puberty. In certain exceptional cases the disease affects the submaxillary glands alone. ”

“ The middle ear may participate in the general destruction, and the patient is left permanently deaf, if indeed he escape with his life.
The lymphatics, veins, and nerves traversing the parotid are affected by the suppuration in the gland. Irritation of the lymph-vessels results in swelling, tenderness, and suppuration of the lymph-glands. Thrombi form in the jugular vein and its branches, and by breaking down lead to septicæmia and ichorization of the sinuses of the dura mater. ”

“ We might be surprised to be told that these parotid glands can have anything to do with the sex organs, but there is no other remote organ that has such a close and rather mysterious relationship with the sex-glands as have the parotids. When the parotid glands, either one or both, are inflamed, the testicles or ovaries are also liable to be attacked by inflammation. ”

“ The outer surface is covered with hair; the inner surface is smooth and somewhat folded. The buccal cavity is rather small. On the inner surface of the cheek open the duct of the parotid (Steno’s duct) , the ducts of the molar gland, and that of the infraorbital gland.
The roof of the mouth cavity is formed by the hard and soft palates. The hard palate (palatum durum) forms the cranial part of the roof; it is supported by the palatal plates of the maxillary and palatine bones. The mucosa of the hard palate is elevated to form seven or eight curved transverse ridges, which are concave caudad. ”

“ Above the gland reaches to the zygoma, and below to the level of the angle of the jaw, where a strong process of the deep cervical fascia, called the stylo-mandibular ligament, separates it from the submaxillary gland; indeed the parotid is often described as lying in a bag formed by deep cervical fascia. The outline of the gland is obscured by several processes, one of which, the facial lobe, runs forward, superficial to the masseter muscle, accompanying the duct. ”

“ Children scarcely ever have occasion to use their teeth. The food in use requires no chewing. Little demand is made upon the salivary glands (for food is hot, moist, and “goes down itself”) ; hence these glands, which consequently fail to develop normally, become at some time acutely diseased, or finally almost if not entirely useless. Hollow, sunken cheeks result from this cause. It was never designed to remedy this defect with fat. The parotid glands and the cheek muscles should be developed and maintained by physiological eating. ”

“ Research is as active as ever in France. M. Bernard, who is well known as a physiologist and anatomist, after a careful study of the salivary glands, finds that each of the three, common to nearly all animals, furnishes a different secretion. The saliva from the sublingual gland is viscous and sticky, fit to moisten the surface of substances, but not to penetrate them, giving them a coat which facilitates their being swallowed. ”

“ Mouth breathing is the cause of many ills. As a result of this, the mucous membrane of the tongue, &c., becomes dry, micro-organisms multiply and the mouth becomes foul. Also from disease of the nose, the upper jaw, palate and teeth do not make proper progress in development. There is overgrowth of tonsils, and adenoids, with resulting deafness, and the child’s mental development suffers. An ordinary “sore throat” usually signifies acute catarrh of the fauces, and is of purely organismal origin, “catching cold” being only a secondary and minor cause. ”

“ The cavity, or opening between these vocal chords is called the glottis: it possesses the power of expanding or contracting under the influence of the muscles of the larynx. The pharynx is a cavity above the larynx, communicating with the nasal passages: it is partially visible when the mouth is opened and the tongue lowered. Near this part of the root of the tongue is situated the epiglottis, which acts as a lid or cover in closing over the air-tube during the act of swallowing. The mouth forms a cavity to reflect and strengthen the resonance of the vibrations produced in the air-tube ”

“ Although most glands are not under direct nervous control, some are as completely under this control as the majority of muscles are. The best examples of this condition are the sweat glands and the salivary glands. The fact that when the nerves supplied to the salivary gland are stimulated, secretion may take place at a pressure higher than that of the blood supplied to the gland shows conclusively that the production of saliva is not a simple organic filtration process, but is dependent upon action called forth in the secretory cells by a nervous impulse. ”

“ Mouth breathing always justifies an examination of the baby’s throat by the best specialist at command.
A mother should know why her baby does not speak distinctly from the day it first forms words. The normal child is born a mimic. It tries its best to speak precisely like the older persons with whom it comes in contact. If the speech is defective, thick, guttural, and unintelligible, a physician should examine the mouth, throat, and nose. There may be a growth in the passageway, enlarged tonsils, trouble with the palate, or the child may be tongue-tied. ”

“ The premaxillary part of the fronto-nasal process separates the nasal cavity from the mouth in front, but behind that the cavity is the rudiment of the mouth and nose which no palate has yet appeared to separate. In Reptiles the hard palate appears, and henceforward the digestive and respiratory tracts only form one passage in the pharynx. In mammals definite lips provided with muscles first appear, though the Monotremes have such specialized mouths that lips are not found in that order. Many monkeys have the vestibule enlarged to form the cheek pouches. (F. G. P.) ”

“ With many there is no trouble, but there are also quite a number of patients whose throats are so irritable from disease as to prevent the introduction of the laryngoscope. In other cases the patient's tongue has an almost irresistible tendency to keep rising up toward the roof of the mouth and thus obstruct the view. Enlargement of the tonsils according to the degree of their enlargement makes an examination either very difficult, or else, if so much enlarged that they meet and almost close up the throat, makes it impossible until the enlargement has been reduced. ”

“ In those who survive, the voice has a peculiar nasal twang, as in phonation the air is expelled through the nose instead of through the mouth, and the articulation, especially of certain consonants, is very indistinct. Taste and smell are deficient. The constant exposure of the nasal and pharyngeal mucous membrane renders it liable to catarrhal inflammation and granular pharyngitis. ”

“ But, even after total extirpation of the tongue, persons have been known to retain the faculty of speech without serious impairment. A case of this character is related by Roland, surgeon to the French court in 1630. It is that of a boy who lost his tongue, when six years old, from gangrene, the result of an attack of small-pox. At the time he came under observation, three years later, all that remained of the organ was a slight, double prominence, flattened and attached to the floor of the mouth, extending from the inside of the chin to the oval aperture of the throat. ”

“ The vocal apparatus is perfected by the addition of the cavities which produce resonance, viz., the pharynx, the mouth, and the nasal fossæ. The pharyngeal cavity, into which open the œsophagus and the larynx, is continuous with the buccal cavity, a hollow box admirably adapted for articulation. Its shape and size are extremely variable. The cheeks constitute walls which can be compressed or dilated with the slightest effort; the lips, which bound the anterior opening, are perfectly mobile; the tongue can be moved in every direction ”

“ The secretions of the mouth overflow the borders of the laryngeal opening and fall into the tube below. Fluids are swallowed with greater difficulty than solids. The voice is not altered except in cases where the crico-thyroids, one or both, are involved, as in complete paralysis of the superior laryngeal nerve. The effort to close the glottis, as in the preliminary act of coughing, is accomplished with difficulty. The sound of the cough is somewhat altered. This is for want of the reinforcement to the adductors furnished by the closure of the vestibule of the larynx. ”

“ When the adenoids encroach upon the Eustachian cushions, the patient suffers from deafness, frequent attacks of earache, and sometimes from suppurative otitis media with a discharge from the ear.
Among the rarer conditions attributed to adenoids are asthma, inspiratory laryngeal stridor, persistent cough, chorea, and nocturnal enuresis.
A diagnosis should never be made from the symptoms alone; an attempt must be made to examine the naso-pharynx by posterior rhinoscopy and by digital examination. The interior of the nose must always be examined and any further cause of obstruction excluded. ”

“ Food particles collect in the mouth and provide culture material, and there are many crypts and irregularities of surface which oppose mechanical cleaning. Infection of the middle ear, the most common cause of deafness, takes place by means of the Eustachian tube which connects the cavity of the ear with the mouth. Organisms from the mouth can extend into the various large salivary glands by means of the ducts and give rise to infections. The tonsils, particularly in children, provide a favorable surface for infection. ”

“ If we remember that the larynx, which is the cavity in the throat behind the tongue, is capable of considerable flexibility, as well as the trachea or windpipe, we have good materials for ventriloquial effect; thus the mouth and tongue have really, but not apparently, a great deal to do with the modifications of the assumed voice. A clever ventriloquist recommends the mouth to be kept closed, and the tongue rolled back, so as to regulate, as it were, the sound which is formed in the larynx. This may be done by strengthening the abdominal muscles ”

“ One anatomical fact may be so invincible that a view of the glottis cannot be obtained at all: the epiglottis may so overhang the opening to the larynx that a good view of its interior is absolutely impossible, in other cases only occasionally and under very favorable circumstances. Such cases are, however, of the rarest occurrence, while there are not a few persons in whom one may even see down the windpipe as far as its division into the two main bronchial tubes, and inflammation may thus often be traced from the vocal bands far down the mucous membrane common to the larynx, windpipe, etc. ”

“ On direct examination the tongue is found swollen, thickened, immobile, painful, and occupying the whole of the oral cavity, sometimes projecting beyond the region of the incisors, and preventing the mouth being closed. Inflammation may become so intense that the point of the tongue hangs out of the mouth. It becomes blackish, bleeding, swollen, and excoriated by contact with foreign bodies or simply with the row of incisor teeth. The saliva becomes fœtid, blood-stained and purulent, and contains large quantities of broken down epithelial cells. ”

“ Pressing the tongue downwards, provided it be done very gently, is also of advantage. Rude treatment the tongue at once resists. The forefinger can be passed into the throat, beyond the epiglottis, as low as the bottom of the cricoid cartilage, and thus search the pharynx down to the top of the œsophagus, and the hyoid space (on each side) where foreign bodies are so apt to lodge. ”