Plastic surgery; its principles and practice . Pig. 698.—Operation for fistula of Stensons duct (Crouse).—i. The skin is retractedand the fascia over the parotid is exposed. Note the clamp which is passfed beneath theskin and over the anterior margin of the masseter muscle. 2. The cheek turned out anda thick flap of mucous membrane and submucous tissue is raised, itte pedicle being oppositethe second molar tooth. The insert shows the closure of the mucous ^ Pig. 699.—Operation for fistula of Stensons duct, continued, i. The mucous flapdrawn through the tunnel made by the clamp. Note
Plastic surgery; its principles and practice . Pig. 698.—Operation for fistula of Stensons duct (Crouse).—i. The skin is retractedand the fascia over the parotid is exposed. Note the clamp which is passfed beneath theskin and over the anterior margin of the masseter muscle. 2. The cheek turned out anda thick flap of mucous membrane and submucous tissue is raised, itte pedicle being oppositethe second molar tooth. The insert shows the closure of the mucous ^ Pig. 699.—Operation for fistula of Stensons duct, continued, i. The mucous flapdrawn through the tunnel made by the clamp. Note the modified Lembert suture whichwill draw the tip of the flap under the edge of the slit in the parotid fascia. Note the gutter-shape assumed by the flap. 2. The loop of ten-day catgut lying in the bottom of thegutter is tied to the Lembert suture. A few sutures placed in the margins of the flap willtend to form a tube. Anastomosis Between the Parotid and Submaxillary Glands.— Ferrarinis suggestion of forming an anastomosis between glandularportions of the parotid and submaxillary glands in cases of fistulaeof Stensons duct does not appear to be practical. The restoration of SURGERY OF THE CHEEK 597 the duct by means of a segment of vein, or by a skin graft, has also beentried, but these methods cannot be commended. It has been known for some time that when Stensons duct has beenobliterated by scar tissue close to the gland the gland will atrophy,and t
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