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Objectives: The Salivary Gland Committee of the American Academy of Otolaryngology‐Head and Neck Surgery seeks to standardize terminology and technique for ultrasonograpy used in the evaluation and treatment of salivary gland disorders. Methods: Development of expert opinion obtained through interaction with international practitioners representing multiple specialties. This committee work includes a comprehensive literature review with presentation of case examples to propose a standardized protocol for the language used in ultrasound salivary gland assessment. Results: A multiple segment proposal is initiated with this focus on the submandibular gland. We provide a concise rationale for recommended descriptive language highlighted by a more extensive supplement that includes an extensive literature review with additional case examples. Conclusion: Recommendations are provided to improve consistency both in performing and reporting submandibular gland ultrasound. [ABSTRACT FROM AUTHOR]

Objective: Identify correlations between lymph node characteristics and extranodal extension (ENE)., Study Design: Retrospective chart review., Setting: Tertiary care center., Methods: Patients who underwent neck dissection for oral cavity squamous cell carcinoma from 2004 to 2018 were included, with a starting sample of 496. The primary outcome was ENE in at least 1 lymph node. Additional variables included number of dissected nodes, positive nodes by level, positive lymph node ratio (LNR), and diameter of metastatic deposit and ENE focus. Univariate and multivariate binary logistic regression analyses were performed to determine correlations between included variables and ENE., Results: Of the 496 patients, 233 had nodal metastasis (47.0%). 13,814 nodes were removed, with 714 (5.2%) containing metastasis. Of the positive nodes, 28.0% had ENE, 47.2% did not have ENE, and 24.8% were unknown. The mean ENE diameter was 5.1 mm (SD, 9.9). On univariate logistic regression analysis, ipsilateral neck LNR per 0.1 unit increase (odds ratio [OR] 1.16, 95% confidence interval [CI] 1.02-1.32, P  = .02), metastatic deposit size per 1 mm increase (OR 1.06, CI 1.04-1.08, P  < .0001), and clinical T- ( P  = .02) and N-class ( P  = .0003) significantly correlated with ENE. On multivariate logistic regression analysis, size of metastatic deposit (OR 1.06, CI 1.03-1.08, P  < .0001) remained significantly correlated with ENE., Conclusion: Controlling for confounding variables, size of metastatic deposit was an independent predictor of ENE, suggesting that as the metastatic deposit size increases, the odds of extension through the capsule also increases. This may be due to capsule thinning as the deposit grows or could represent the invasive nature of aggressive disease., Competing Interests: None., (© 2024 The Author(s). OTO Open published by Wiley Periodicals LLC on behalf of American Academy of Otolaryngology–Head and Neck Surgery Foundation.)

Objectives: The presence of a catheter required for contrast infusion during sialography obscures imaging of the distal duct. Static imaging via cone beam computed tomography and magnetic resonance sialography fails to address changes that occur dynamically to the anatomy of the flexible salivary ductal system. We aim to identify dynamic changes to the parotid gland by introducing a novel approach to analyze the full extent of Stensen's duct based on dynamic infusion digital sialography. Methods: Retrospective chart review of a single-center consecutive series of 409 parotid sialograms performed between April 2008 and June 2023 permitted selection of a contemporary series including seven normal sialograms and seven sialograms with stricture(s). Dynamic (fluoroscopic) infusion (iopamidol/gadolinium) sialograms were assessed through blinded review by two radiologists employing the institution's picture archiving and communication (PACS) system (©2023 Koninklijke Philips N.V., Amsterdam, Netherlands). Measurements determined changes, in two dimensions, to the angle of the masseteric bend and duct length while the catheter was in place (repose), during catheter withdrawal (stretch), and during recoil after withdrawal. Differences in median lengths and angles of Stensen's duct between the three time points were compared using Wilcoxon matched-pairs signed rank and Mann-Whitney tests. Results: Fourteen patients [median age (IQR), 55 years (24.7); 10 women] were evaluated. The median angle of the masseteric bend was 117.7° in repose versus 155.4° during catheter withdrawal ( P < .001, n = 14). The median distance measured from the Stensen's duct orifice to the first major ductal bifurcation was 81.5 mm (IQR = 12.3) in repose. The median percent increase in length from repose to stretch was 6.3% ( P < .001, n = 14). Conclusions: Dynamic infusion digital sialography with fluoroscopic recording during catheter removal permits assessment of the distal duct unobstructed by the presence of a catheter. The technique also identifies the dynamic nature and varying length and angulation of Stensen's duct., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: Henry T. Hoffman, MD—Research Consultant for MeiraGtx and RiboX; author for UpToDate.

Background: Management of submental gunshot wounds is becoming more common and requires complex surgical decisions. Objective: Compare outcomes of early and definitive reconstructive techniques following submental gunshot wounds. Methods: Retrospective chart review evaluated subjects who sustained a self-inflicted submental gunshot. The incidence of complications requiring unplanned operations was compared for early management techniques of skin/soft tissue, bone, and mucosal lining and definitive reconstructive techniques using Fisher's or Pearson Chi-square exact test with p ≤ 0.05 considered statistically significant. Results: The total of 27 patients were included. Early techniques included skin = primary soft tissue closure ( n = 19) versus wound vacuum-assisted closure ( n = 8); mandible = open reduction internal fixation (ORIF) ( n = 19) versus external fixation ( n = 8); and oral mucosal lining = primary mucosal closure ( n = 20) versus dermal substitute ( n = 7). Definitive management included ORIF ( n = 10, 37%), ORIF with bone grafting ( n = 8, 30%), and microvascular free-flap ( n = 9, 33%). The incidence of complications requiring unplanned operation when using dermal substitutes for mucosal lining management was statistically higher than primary closure ( p < 0.001); otherwise the complication rates of surgical techniques were equivalent. Conclusion: Several surgical decisions and techniques can be utilized at the time of early and definitive management of submental gunshot wounds. Only the use of dermal substitutes for mucosal lining is associated with a significantly higher rate of unplanned operation.