OBJECTIVE: This study aimed to investigate the potential of a newly developed small electrode to accurately record muscle activity during swallowing.
METHODS: This study included 31 healthy participants. The participants underwent swallowing trials with three types of material. The recordings involved the following conditions: 1) swallowing saliva, 2) swallowing 3 mL water, and 3) swallowing 5 mL water. Two types of electrodes, a conventional electrode (CE) and a newly developed small electrode (NE), were symmetrically positioned on the skin over the suprahyoid muscle group, starting from the center. From the surface electromyography data, the swallowing duration (s), peak amplitude, and rising time (duration from swallowing onset to peak amplitude: s) were measured. Additionally, the equivalence of characteristics of the waveform of muscle activities was calculated by using the variance in both the upper and lower confidence limits in duration and rising time.
RESULTS: No significant differences in baseline, swallowing duration or rising time between the CE and NE were observed for any swallowing material. The peak amplitude was significantly higher for the NE than for the CE for all swallowing materials. The CE and NE displayed no significant difference in the equivalence of characteristics of the waveform of muscle activities for any swallowing material.
CONCLUSIONS: The gold-plated small electrodes utilized in this study indicated the ability to record the same characteristics of muscle activity as conventional electrodes. Moreover, it was able to capture the muscle activity of each muscle group with improved sensitivity in a narrow area, such as under the submandibular region, with more precision than that of conventional electrodes.

Transoral sialolithotomy performed in-office under local anesthesia is routinely performed for distal submandibular stones. We demonstrate the senior author\'s novel practice of in-office transoral sialolithotomy for hilar and intraglandular stones. A review of cases performed by the senior author revealed similar rates of complication and stone recurrence as those reported in the literature from removal under general anesthesia. Laryngoscope, 2024.

Epidermoid cysts rarely present in the submandibular area, constituting approximately less than 7% of all cystic lesions in the head and neck region and less than 0.01% of all oral cavity cysts. Therefore, epidermoid cysts can be easily misdiagnosed, as the differential diagnosis for a submandibular area mass is very broad. Imaging can help define characteristics of the mass; however, a pathologic specimen is usually required for the final diagnosis. Surgical excision is often required and tolerated well by most patients. However, there is a risk of recurrence of the cyst after excision, as well as a rare chance for malignant transformation if not excised, which must be discussed with the patient at the time of diagnosis of epidermoid cyst. We present a 33-year-old Caucasian female with a left submandibular cystic mass measuring 4.7 cm x 2.9 cm, that was originally thought to be a plunging ranula and subsequently diagnosed as an epidermoid cyst. This report is meant to raise awareness of the possibility of a submandibular mass being an epidermoid cyst as well as appropriate workup, treatment, and prognosis of epidermoid cysts in the submandibular region. This report also describes a unique approach to a submandibular epidermoid cyst of which the submandibular gland is divided for access to the cyst for safe and effective excision. To the author\'s knowledge, this surgical approach has not been described in the literature for a submandibular epidermoid cyst.

UNASSIGNED: 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.
UNASSIGNED: 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.
UNASSIGNED: 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.
UNASSIGNED: Recommendations are provided to improve consistency both in performing and reporting submandibular gland ultrasound.

OBJECTIVE: systemic sclerosis (SSc) is an autoimmune disorder with multiple organs destruction. This study aimed to identify the ultrasonographic changes of major salivary glands in Egyptian scleroderma patients and to detect their association to different disease manifestations.
METHODS: Forty-seven SSc patients and 43 apparent healthy volunteers were enrolled. Demographics, inflammatory markers, and autoimmune status were recorded. Ultrasound evaluation of salivary glands was performed. Salivary gland changes\' associations were statistically examined with SSc susceptibility and disease manifestations.
RESULTS: Thirty-one SSc patients exhibited glandular pathology (p < 0.0001), compared to controls. Of these abnormalities, SSc patients showed a total parotid gray scale of 2, total submandibular gray scale of 2, total glandular gray scale of 4, and total glandular Doppler signal of 1 at p < 0.0001, compared to the control group. Patients with SSc and glandular pathology had a higher prevalence of arthritis (p = 0.029) and ESR (p = 0.002) than those with normal glandular ultrasound. Significant associations were reported between gray scale ultrasound (GSUS) of total parotid (odds ratio \"OR\" = 0.4), total submandibular (OR = 0.36), and total glandular (OR = 0.53) with susceptibility to SSc at p < 0.0001. Total glandular GSUS (p = 0.039) and total submandibular power Doppler (p = 0.044) correlated with the SSc duration. Total parotid GSUS (p = 0.008) and total glandular GSUS (p < 0.0001) correlated with Schirmer\'s test.
CONCLUSIONS: Major salivary glands are affected in SSc. Hence, scanning these glands with ultrasound is an additive tool besides the current practice. Key Points • Major salivary gland changes, observed by ultrasonography, are new findings in Egyptian SSc patients. • Ultrasound changes of major salivary glands are associated with inflammatory markers and clinical manifestations of SSc. • Scleroderma ultrasonography scans of the main salivary glands could be added to the routine work.

Salivary stones are termed as sialoliths, and the condition is referred to as sialolithiasis. Pain and swelling in the affected area, especially after eating, occur often. Small, easily accessible stones may be managed with conservative methods, such as milking of ducts, along with palliative care, whereas bigger, more difficult-to-reach stones need surgical removal. In this article, we describe a case of sialolithiasis affecting the right submandibular salivary gland, which was treated by removing the gland and stone surgically. When big stones and the gland are removed extra orally, the results are favorable. Submandibular gland sialoliths are the most frequent kind of salivary gland illness. The treatment of this salivary system problem depends on the patient\'s clinical history, the size of the sialolith, and the degree of cooperation.

The parents of an 11-month-old infant presented her to the hospital due to her persistent fever and the presence of a swollen neck over a period of four days. Inflammation and discomfort were observed on both sides of her neck, particularly around the parotid glands. Notably, a localized collection of pus was identified beneath her left jaw while both sides of her jaw exhibited swelling, albeit with less sensitivity. A neck scan revealed an infection in the jaw region, accompanied by swelling in the facial skin and underlying tissue. The diagnosis rendered was Ludwig\'s angina, for which the prescribed course of treatment involved administering intravenous antibiotics such as amikacin, vancomycin, and Meropenem. The patient exhibited improvement after the treatment and was subsequently discharged from the hospital.

Monkeypox virus infection is characterized by a prodromal illness with fever, intense headache, lymphadenopathy, back pain, myalgias, and asthenia, followed by the eruption of skin lesions. A case series has reported monkeypox virus infection with primary anogenital and facial cellulitis. In addition, superimposed bacterial infections have been reported in several case reports. We present a monkeypox virus infection case of a patient presenting with jaw swelling initially thought to be secondary to cellulitis/abscess collection. A 25-year-old homosexual male on HIV pre-exposure prophylaxis presented to an urgent care center with a painful, ruptured, crusted chin lesion. Given recent contact with monkeypox virus-infected patients, a monkeypox swab was collected. He then developed a fever, jaw/neck swelling, and difficulty swallowing, which prompted him to come to our emergency department. He was febrile and tachycardic on presentation. The labs were unremarkable. A CT scan of the neck showed soft tissue thickening within the submental and submandibular regions bilaterally, consistent with cellulitis without evidence of abscess formation. It also showed prominent bilateral submandibular and left station IIA lymphadenopathy. We started the patient on intravenous ampicillin-sulbactam, but his swelling worsened. We suspected abscess formation clinically; however, a percutaneous drainage attempt yielded a dry tap. We added vancomycin for extra coverage, but the patient remained febrile, and his swelling continued to worsen. In the meantime, his monkeypox virus polymerase chain reaction (PCR) swab result returned positive, and he developed other skin lesions. These two findings and the lack of improvement with antibiotic therapy led us to believe that his fever was secondary to monkeypox and the swelling was secondary to reactive lymphadenopathy over true cellulitis. We stopped his antibiotics, and his symptoms improved with a complete resolution of the jaw swelling. This case was challenging to manage as the patient\'s swelling was initially thought to be secondary to cellulitis and abscess collection, but it turned out to be secondary to lymphadenopathy. This case illustrates the significance and severity of lymphadenopathy in monkeypox virus infection, which can be initially misdiagnosed as cellulitis.

OBJECTIVE: To characterize the presentation and treatment of children presenting with primary salivary gland neoplasms.
METHODS: A retrospective review of primary salivary tumor patients presenting to Children\'s Hospital Colorado between January 2000 and August 2020.
RESULTS: Fifty children were identified with primary salivary gland tumors, comprising of 39 (78 %) benign and 11 (22 %) malignant lesions. Pleomorphic adenoma was the most common benign tumor (36/39, 92 %), while acinic cell carcinoma was the most common malignancy (7/11, 64 %). The parotid gland was the most common site, followed by the submandibular gland (66 % vs. 34 %). No tumors were found in the sublingual glands. Benign neoplasms accounted for 70 % of parotid lesions and 94 % of submandibular tumors. No significant differences in age (13.6 years, SD 4 vs. 13.0 years, SD 4.3) were noted between patients with benign and malignant disease, but tumors in females were more frequently malignant (M:F 1:1.3 vs. 1:2.7 for benign and malignant tumors, respectively). Neck dissection and/or facial nerve sacrifice were required in 27 % (3/11) and 9.1 % (1/11) of malignancies, respectively. Local recurrence was observed in 7.7 % (3/39) of benign cases and 9.1 % (1/11) of malignant cases. No salivary malignancies required chemotherapy, though one patient with neurofibromatosis received imatinib prior to resection. Two patients with locoregional malignancy received adjunctive radiation. The average duration of follow up for benign and malignant disease were 12.6 ± 25 and 45.1 ± 32 months, respectively.
CONCLUSIONS: This study presents one of the larger single institutional experiences of pediatric primary salivary neoplasms in the past 20 years, identifying pleomorphic adenoma and acinic cell carcinoma as the most common benign and malignant etiologies, respectively. While this review found most neoplasms presented as a localized mass effectively managed with conservative surgical resection, aggressive tumors required multidisciplinary care.

Submandibular sialadenitis is a common ailment in otorhinolaryngological and oral surgical practice. Some of the common causes of sialadenitis include sialolithiasis, inspissated mucous plugs, strictures and anatomical ductal variations. Very rarely do foreign bodies cause obstructive sialadenitis. Fish bone as a foreign body is routinely seen, with the most common locations being oropharynx, hypopharynx, oseophagus and tongue. We report an intriguing case of a 40 year old male with sialadenitis of the right submandibular gland due to an intra-ductal fish bone.