Breaking it down: Review and management of sialendoscopy device malfunctions.

PURPOSE: The present study was aimed at determining common causes of sialendoscopy device malfunctions and identifying a uniform algorithm to manage device failures. MATERIALS AND METHODS: The FDA Manufacturer and User Facility Device Experience (MAUDE) database was searched for various keywords related to sialendoscopy. Reports between the dates of December 1, 2009 to March 31, 2020 were downloaded for review and included in the study. Variables such as: device, the iatrogenic injury type, and subsequent surgical or medical intervention were collected and details of the malfunction were categorized based on the type of malfunction. RESULTS: 206 medical device reports were identified; 47 of them which met inclusion criteria (106 were duplicate cases and 53 were irrelevant to the present study). The majority of device malfunctions involved salivary stone extractor baskets (SSEBs), (40/47; 85.1%), followed by malfunctions of balloon dilators (3/47; 6.4%) and sialendoscopes (2/47; 4.3%). Retention of the SSEB was noted in 85% of the SSEB malfunctions. CONCLUSIONS: Given that sialendoscopy is an increasingly popular technique that relies on devices, it is inevitable that device failures will occur for a multitude of reasons. Working to prevent these malfunctions from occurring is the most effective method of harm reduction. Though it is important that sialendoscopists have a discrete, algorithmic approach to manage them when they occur.

Incorporating Sialendoscopy into the Otolaryngology Clinic.

Simple sialendoscopy procedures may be performed in the outpatient clinic with few complications. This process spares patients the risks, increased cost, and time burdens of sialendoscopy under general anesthesia. Sialendoscopy procedures may be incorporated into the outpatient practice after gaining experience with these procedures in the operating room. Diagnostic sialendoscopy, dilation of stenosis, and endoscopic sialolithotomies of small, freely mobile stones are appropriate for in-office sialendoscopy in many instances.

The Virtual Mock Oral Examination: A Multi-institutional Study of Resident and Faculty Receptiveness.

Due to the coronavirus disease 2019 (COVID-19) pandemic, several American Board of Medical Specialties members have implemented board exams in an online format. In response, we decided to evaluate the efficacy and receptiveness of otolaryngology faculty and residents to a web-based virtual mock oral examination (MOE). Faculty and residents from DC-metropolitan institutions were recruited for decentralized virtual MOE in early 2020. A total of 28 faculty and 20 residents signed up. Follow-up included a survey study consisting of Likert scale and free-text questions to evaluate receptiveness. Helpfulness of the exercise was rated as an average of 8.8 and 9.06, respectively, by faculty and residents on a 10-point Likert scale. Likelihood to recommend a similar exercise to others was 9.2 and 9.3, respectively, for faculty and residents. All survey respondents said they would participate again if given the opportunity. We conclude that existing videoconferencing technologies can be effective tools for conducting virtual MOE by otolaryngology residency programs.

Coupling Pressure Sensing with Optical Coherence Tomography to Evaluate the Internal Nasal Valve.

PURPOSE: To evaluate endoscopic long-range optical coherence tomography system combined with a pressure sensor to concurrently measure internal nasal valve cross-sectional area and intraluminal pressure. METHODS: A pressure sensor was constructed using an Arduino platform and calibrated using a limiter-controlled vacuum system and industrial absolute pressure gauge. Long-range optical coherence tomography imaging and pressure transduction were performed concurrently in the naris of eight healthy adult subjects during normal respiration and forced inspiration. The internal nasal valve was manually segmented using Mimics software and cross-sectional area was measured. Internal nasal valve cross-sectional area measurements were correlated with pressure recordings. RESULTS: Mean cross-sectional area during forced inspiration was 6.49 mm2. The mean change in pressure between normal respiration and forceful inspiration was 12.27 mmHg. The direct correlation between pressure and cross-sectional area as measured by our proposed system was reproducible among subjects. CONCLUSIONS: Our results demonstrate a direct correlation between internal nasal valve cross-sectional area and nasal airflow during inspiration cycles. Endoscopic long-range optical coherence tomography coupled with a pressure sensor serves as a useful tool to quantify the dynamic behavior of the internal nasal valve.

In Vivo Accuracy of Ultrasound for Sizing Salivary Ductal Calculi.

OBJECTIVES: The present study was developed to evaluate the accuracy of in vivo ultrasound sizing for parotid and submandibular salivary gland calculi, as compared with ex vivo pathology sizing with a standard plastic ruler after extraction. STUDY DESIGN: Retrospective chart review. SETTING: Ultrasound is frequently used to size salivary calculi and make treatment decisions, but the accuracy of measurements from this modality has not been validated. SUBJECTS AND METHODS: We evaluated and reviewed the charts and ultrasound examinations of 167 patients who underwent procedures for the treatment of sialolithiasis involving the parotid and submandibular glands. US examinations were performed between 2009 and 2016 in a tertiary-level hospital setting by the senior author. Measurements were collected from ultrasound evaluation before sialolithotomy, and pathology measurements were taken after removal. Ultrasound measurements in millimeters were compared with the measurements collected with a ruler. The differences were calculated and compared. RESULTS: A total of 167 calculi measurements were compared. Good concurrent validity between pathology and ultrasound measurements was suggested by a Pearson correlation of 0.92 (95% CI, 0.887-0.937). On Bland-Altman plot, correlation of the difference between US and pathology measurements showed a mean difference of 0.095 mm (95% CI, -0.19 to 0.38 mm) with a limit of agreement ranging from -3.59 mm (95% CI, -3.84 to -3.34 mm) to +3.78 mm (95% CI, +3.53 to +4.03 mm). CONCLUSIONS: Ultrasound is an accurate, relatively precise, and minimally invasive imaging tool for salivary gland sialolithiasis. Preoperative size of calculi can be used to guide management and clinical decision making. LEVEL OF EVIDENCE: 2C.

Minimum fascia tumor distance for selection of extracapsular dissection for benign parotid tumors: A preliminary study.

OBJECTIVE: There is increasing literature supporting the use of extracapsular dissection (ECD) for the treatment of select superficial lobe parotid tumors, though no objective criteria for selection has been proposed. Prior studies have suggested the minimum distance between the parotideomasseteric fascia and the tumor edge or minimum fascia-tumor distance (MFTD) as a useful measurement for the identification of superficial parotid tumors. The objective of this study is to demonstrate the utility of the minimum fascia-tumor distance in selecting candidates for extracapsular dissection of benign parotid tumors. METHODS: This is a retrospective case-control study at a tertiary academic otolaryngology clinic. Twenty-three patients with prior surgical excision of benign parotid tumors that underwent surgeon-performed ultrasonography prior to excision of tumor were identified. Ultrasound images were reviewed and the minimum fascia-tumor distance was recorded and categorized by less than 3 mm or as 3 mm or greater. The primary outcome was successful completion of extracapsular dissection versus more extensive resection. RESULTS: Thirteen patients had a minimum fascia-tumor distance less than 3 mm; eleven of thirteen (84.6%) successfully underwent extracapsular dissection. Ten patients had a minimum fascia-tumor distance of 3 mm or greater; one of ten (10%) successfully underwent extracapsular dissection. A minimum fascia-tumor distance less than 3 mm was sensitive, specific, and accurate in predicting successful ECD at 91.7%, 81.8%, and 87.0% respectively (OR 49.5, 95% CI 3.4-573.2). CONCLUSION: Minimum fascia-tumor distance may be a useful measurement in identifying candidates for removal of benign parotid tumors with extracapsular dissection.

Salivary gland ultrasound training: Improving anatomic identification in residents.

OBJECTIVES/HYPOTHESIS: The aim of the study was to introduce and study the role of standardized views for ultrasound of the major salivary glands in resident learning and retention. STUDY DESIGN: Methods description and prospective case series. METHODS: Five otolaryngology residents and two patient models were recruited for this study. The participants were timed on their identification of the submandibular gland, sublingual gland, and parotid gland and associated key anatomic structures. Participants were then timed again immediately after being presented a standardized view for each salivary gland: the longitudinal submandibular gland, transverse parotid gland, and submental transverse views. The same participants were then timed one month later to determine retention. A Wilcoxon signed-rank test was used to evaluate whether time to identification was equal pre- and post-standardized view instruction. RESULTS: There was a significant improvement from pre- to post-standardized view instruction in all glands, which was sustained one month later. Practically speaking, assessment times for all participants at the one-month measurement were reasonable, with averages of 71, 42, and 114 s for the submandibular gland, sublingual gland, and parotid gland respectively. CONCLUSIONS: Standardized views provided otolaryngology ultrasonography learners with a reliable, fast, and memorable way to assess the salivary glands and their related structures. LEVEL OF EVIDENCE: 4.