Recurrent swellings of the parotid gland

It will be seen that the largest group of cases occurs in the first two decades. There is a fall in the 20 year group followed by a high level after the age of 30 years. It is noticeable that whereas males predominate under the age of 20 females are greatly in excess after 30 years. Rose (1954), in his analysis of a rather larger group of mixed cases, also drew attention to the preponderance of females in the older group, as has Payne (1933, 1940). Jones (1953) records a slight excess of males over females in a group of 17 children. The investigation has been undertaken on the basis of history, physical examination of the swellings and of Stenson's duct, examination of saliva obtained from the duct, and sialography. All these contribute to the diagnosis but for the moment the results of sialography only will be considered. For this a long No. 22G needle with solder attached 3-5 mm. from the distal end was used (Fig. 1). The solder can be wedged up against the duct orifice to prevent reflux. A watery solution of neohydriol is injected: Most normal duct systems will accommodate i-1 ml. without rupture of the acini but when the main ducts are dilated 2 or 3 ml. may be required to obtain adequate filling. Sialograms fall into four main patterns: 1, Normal appearance; 2, dilatation of the terminal ducts or acini; 3, dilatation of the main and/or main branch ducts; 4, filling defects in main or branch ducts due to calculus with dilatation of ducts distal to obstruction. The presence of tumours may be indicated by displacement of the branch ducts, and parenchymatous swellings by separation of the ducts from one another. Those cases falling into groups 2 and 3, according to age and sex, are analyzed in Table II.