and if the
facial and auriculo-temporal nerves are damaged, motor and sensory
paralysis of the parts supplied by them ensues. Wounds of the parotid
heal rapidly and without complications so long as infection is
prevented, but if suppuration takes place they are liable to be
followed by the escape of saliva, which may go on for weeks; in some
cases a salivary fistula is thus established.

_The parotid duct_ may be divided and a salivary fistula result. If
the external wound heals rapidly, a salivary cyst may develop in the
substance of the cheek, forming a swelling, which fills up at meals,
and may be emptied by external pressure, the saliva escaping into the
mouth.

In a wound implicating the whole thickness of the cheek the skin
should be accurately sutured, care being taken that the stitches do
not include the duct, but in order that the saliva may readily reach
the mouth, the mucous membrane should not be stitched.

#Salivary Fistulae.#--A salivary fistula may occur in relation to the
glandular substance of the parotid or in relation to the duct. Fistula
in connection with the glandular substance--_parotid fistula_--seldom
results from a wound, made, for example, in the removal of a tumour or
in an operation on the ramus of the jaw, so long as it is aseptic; but
as a sequel of suppuration in the gland, and particularly of an
abscess developing around a concretion, it is not uncommon. The
fistulous opening is usually small, and may occur at any point over
the gland. The fistula may be dry between meals, or the saliva may
escape in small transparent drops, but the quantity is always greatly
increased when food is taken. A parotid fistula, although it may
continue to discharge for weeks, or even for months, usually closes
spontaneously.

In persistent cases, the edges of the fistula may be pared and brought
together with sutures, or the actual cautery may be applied to induce
cicatricial contraction.

_Fistula of the parotid duct_ is more serious. It is usually due to a
wound, less frequently to abscess or impacted calculus. From the
minute opening, which is most frequently situated over the buccinator
muscle, there is an almost continuous flow of clear limpid saliva,
which is greatly increased in quantity while the patient is eating.
These fistulae show little tendency to close spontaneously. Attempts to
close the opening by the external application of collodion, by
cauterising the edges, or even by paring the