Subramaniam N, et al. - Researchers performed a detailed examination of level Ib involvement in oral squamous cell carcinoma (OSCC) in order to assess the feasibility of submandibular gland-sparing in neck dissection. Further, they investigated the rate of direct involvement by the primary tumours, the involvement of periglandular level Ib nodes, and their determinants. Between 2005 and 2014, they evaluated a total of 586 neck dissection specimens obtained from patients operated on at the study institution, for floor of mouth, tongue, and buccal primaries, for direct invasion of the gland and periglandular lymphadenopathy. Depth of invasion >10 mm, perineural invasion, lymphovascular invasion, and moderate/poor differentiation were identified as the determinants of periglandular lymphadenopathy. In early tumors, they identified gland-sparing neck dissection as safe, with a good chance of minimizing xerostomia without radiotherapy. Gland preservation could be considered in larger tumors without clear evidence of submandibular gland invasion or suspicious level Ib lymphadenopathy, however, the oncological safety is unclear.