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Show or THE samvanv FISTULA. .l'o' 19 or ms L'LA. trou~ ning without pain, the feeling of distension being alone patients I blesome. Such indeed has been the account of the an obstruc- have seen with this complaint ; but I know that complaint, l (ion of the salivary ducts is an extremely painfu salivary and so peculiar in the pain and distension of the on the or food, sapid g tastin glands, under the tongue, upon duct, they may be drawn out with forceps ; or the calculus produces much irritation, and a suppurating sac is formed. After the extraction of the calculus, the injection of a slightly astringent fluid, with the syringe for fistula lacrymalis, cures it. UP THE SALIVARY FISTULA. t would not action of the muscles of the jaw, that the patien be apt to overlook the beginning of the disease. a If we say that Ranula is a semipellucid tumour, like the kinds, two frogis belly, under the tongue, then there are one arising from the distension of the salivary duct ; the other, a simple incysted tumour. I believe they have been much confounded. If we define it to be a distension of the salivary ducts, then it is not always under the tongue, but is common to the other ducts. This complaint, under the tongue 1 have seen in an infant, and I believe it is frequent in them, from original obstruction of the duct. In adults, it is sometimes found to be complicated with, and to have taken (Silas-ow mun {1 i l k: its origin from salivary calculi in the mouth of the duct. When it is in its most frequent place, under the tongue, and is allowed to grow, it forces back the tongue, and oc-ca~~ sions difficulty of swallowing, and inarticulate speech ; and in children it prevents sucking. It would appear that this is sometimes a much firmer tu~ mour than those I have seen, insomuch, that, by pressing THIS fistula differs essentially from other fistulous sores, connected with the natural ducts, or passages. It is not the consequence of obstruction, but of cuts upon the cheek : for it is on the cheek that they chiefly occur, from the very exposed situation of the duct of the parotid gland. This sore forms a fistula of a very unpleasant kind ; since while sitting at dinner, or when masticating, the flow of sali< va, is very profuse, and a failure of appetite, we are told, is the consequence of this discharge. I doubt the truth of this latter circumstance. If there occur a recent division of the duct, by a wound penetrating the cheek, near its termination, we have only to take care that in using the twisted suture, the skin of the cheek be very accurately united, while the inside of the cut is left free, for the discharge of the saliva, from the duct, in» to the month. When we do this, the duct may chance to unite again, or though it do not, yet if the outward skin be united, the saliva will find its way into the mouth. forward, it has affected the teeth, and so far pressed back the The chance however is, that the case presents in the form tongue, as to occasion difficulty of breathing. When formed in the check, it has forced itself under the zigonla, and has prevented the free motion of the jaw. The practice is, to lay these tumours freely open. Unless this be done freely, it will return. In its return it will often lose its transparency, and by the necessity for frequent punt" lures, it becomes a thick and fleshy bag, requiring either ex» tirpation, or escharotic and caustic dressings. of callous holes, discharging saliva.' In which vain attempts have been made to cure the sore, by compresses, and escharo~ ties. The duct may have been divided, as it passes over the masseter muscle, and of course without. the wound penetrating the mouth. In this case of a fistula of some continuance on the cheek, we have to establish a. communication betwixt the duct. CALCULI form in the salivary ducts ; sometimes they lodge and the mouth, and then to heal the outward wound. Our first attempt will be, to pass a small silver probe, from the near the mouth of the duct, without producing a tumour, and then with the touch of a lancet over the extremity of thr mouth into the natural opening of the duct and enlarge it, if |