The purpose of this publication was to inform surgeons as to the modern state‐of‐the‐art evidence‐based guidelines for management of the recurrent laryngeal nerve invaded by malignancy through blending the domains of 1) surgical intraoperative information, 2) preoperative glottic function, and 3) intraoperative real‐time electrophysiologic information. These guidelines generated by the International Neural Monitoring Study Group (INMSG) are envisioned to assist the clinical decision‐making process involved in recurrent laryngeal nerve management during thyroid surgery by incorporating the important information domains of not only gross surgical findings but also intraoperative recurrent laryngeal nerve functional status and preoperative laryngoscopy findings. These guidelines are presented mainly through algorithmic workflow diagrams for convenience and the ease of application. These guidelines are published in conjunction with the INMSG Guidelines Part I: Staging Bilateral Thyroid Surgery With Monitoring Loss of Signal. Level of Evidence: 5 Laryngoscope, 128:S18–S27, 2018

Context.-Fine-needle aspiration (FNA) is a well-established diagnostic approach for salivary gland lesions; however, lack of a standard system of terminology for classification of salivary gland neoplasms collected by FNA and the relatively high frequency of uncertainty of diagnosis are likely partly responsible for current confusion in the interpretation of these FNA samples.Objective.-To propose a novel classification system for reporting salivary gland FNA samples and summarize recent progress in application of molecular and immunohistochemical markers in selected salivary gland neoplasms.Data Sources.-Literature review and authors' personal practice experience.Conclusions.-The new classification system provides a more succinct, standardized interpretation of results and will ultimately assist in communication between clinicians, clinical decision making, and preoperative patient counseling. Impressive advances have been made in recent years in the understanding of molecular pathogenesis of salivary gland tumors. With the newly acquired diagnostic tools, significant improvement in diagnostic accuracy of salivary gland FNA can certainly be expected.(Arch Pathol Lab Med. 2015;139:1491-1497; doi: 10.5858/arpa.2015-0222-RA) M asses or cystic lesions of salivary glands have a wide range of differential diagnoses, from inflammatory response to neoplasm and to less common causes of infection.1 The World Health Organization has described 45 morphologic types of primary salivary gland tumors. Fine-needle aspiration (FNA) is a well-established diagnostic approach for salivary gland lesions. Zbaren et al 3 have noted accuracy, sensitivity, and specificity rates for salivary gland FNA of 79% (87 of 110), 74% (50 of 68), and 88% (37 of 42), respectively. Fine-needle aspiration has a higher sensitivity/specificity for benign masses than for malignancy. 4 Carrillo et al 5 also noted that FNA has the potential to change the clinical approach for up to one-third of patients. Salivary lesions remain, however, one of the most challenging entities in cytopathology, mainly because of the diversity of histologic subtypes and the often overlapping morphologic features of the lesions.

"I have noticed in operations of this kind, which I have seen performed by others upon the living, and in a number of excisions, which I have myself performed on the dead body, that most of the difficulty in the separation of the tumor has occurred in the region of these ligaments…. This difficulty, I believe, to be a very frequent source of that accident, which so commonly occurs in removal of goiter, I mean division of the recurrent laryngeal nerve." Sir James Berry (1887).

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There is no single "best" approach to Zenker's diverticulum. The open, laser, and stapler methods are equally effective and have similar complication rates.

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In the context of an indeterminate fine-needle aspiration biopsy, an elevated index of suspicion for parotid malignancy may be warranted.