Human anatomy; Medicine -- Study and teaching; Palpation
9. =Foramina for branches of fifth nerve.=--As a surgeon may be called
upon to divide any one of the three chief branches of the fifth nerve
upon the face, he looks with interest to the precise situations where
they leave their bony foramina with their corresponding arteries. The
supraorbital notch or foramen can be felt about the junction of the
inner with the middle third of the supraorbital margin. From this point
a perpendicular line drawn with a slight inclination outwards, so as to
cross the interval between the two bicuspid teeth in both jaws, passes
over the infraorbital and the mental foramina. The direction of these
two lower foramina looks towards the angle of the nose.
10. =Pulley for superior oblique muscle.=--By pressing the thumb
beneath the internal angular process of the frontal bone, the
cartilaginous pulley for the tendon of the superior oblique muscle can
be distinctly felt. We should be careful not to interfere with this
pulley in any operation about the orbit.
11. =Lower jaw.=--The working of the condyle of the jaw vertically and
from side to side can be distinctly felt in front of the ear. When the
mouth is opened wide, the condyle advances out of the glenoid cavity
on to the eminentia articularis, and returns into its socket when the
mouth is shut. The muscle which causes this advance is the external
pterygoid; and it gives the jaw a greater freedom of grinding motion.
The posterior margin of the ramus of the lower jaw corresponds with
a line drawn from the condyle to the angle. In opening abscesses in
the parotid region, the knife should not be introduced behind this
line for fear of wounding the external carotid artery. Punctures to
any depth may be safely made in front of it. They are often necessary
where inflammation of the parotid gland ensues after eruptive fevers,
and runs on to suppuration. The swelling, tension, and pain are most
distressing. Owing to the fibrous framework of the gland, the matter
is not circumscribed, but diffused. One puncture is not enough. Three
or more may be requisite. The blade of the knife should be held
horizontally, so as to be less likely to injure the branches of the
facial nerve. We are not to be disappointed if no matter flows. The
punctures give relief, and matter will probably exude the next day.
12. =Parotid duct.=--A line drawn from the bottom of the lobe of the
ear to midway between the nose and the mouth gives the course of the
parotid duct. Opposite the second upper molar, the duct opens by a
papilla into the mouth. The branch of the facial nerve which supplies
the buccinator runs with the duct.
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