{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,28]],"date-time":"2026-01-28T21:24:53Z","timestamp":1769635493031,"version":"3.49.0"},"reference-count":35,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2025,9,10]],"date-time":"2025-09-10T00:00:00Z","timestamp":1757462400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"},{"start":{"date-parts":[[2025,9,10]],"date-time":"2025-09-10T00:00:00Z","timestamp":1757462400000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Head &amp; Neck"],"published-print":{"date-parts":[[2026,2]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Late radiation\u2010associated dysphagia (late\u2010RAD) commonly presents in patients with signs of hypoglossal neuropathy, with hallmark clinical features including lingual atrophy, deviation, and fasciculation. Gold\u2010standard electromyography (EMG) has not been used to explore the frequency of hypoglossal neuropathy in patients with late\u2010RAD.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Exploratory post hoc secondary analysis of MANTLE trial (NCT03612531) was completed. The presence of cranial nerve XII (CN XII) neuropathy was classified by (1) features of clinical assessment as well as (2) intramuscular genioglossus EMG pre\u2010MANTLE intervention in disease\u2010free HNC survivors \u2265\u20092\u2009years post\u2010radiotherapy (RT) with grade \u2265\u20092 fibrosis and dysphagia.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>All 13 patients with late\u2010RAD (median 8.3\u2009years post\u2010RT) who consecutively underwent needle EMG had neurophysiological evidence of hypoglossal neuropathy, while 31% of neuropathy cases were subclinical without clear clinical signs of denervation. Exploratory subgroup analyses revealed worse function and fibrosis among late\u2010RAD cases whose neuropathy had progressed to clinical stages.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Findings suggest that hypoglossal neuropathy is universally present in patients with fibrosis\u2010related late\u2010RAD, supporting a hypothesis that cranial neuropathy is in the mechanistic pathway. Subclinical hypoglossal neuropathy is evident on EMG assessment before clinical presentation at earlier stages of functional impairment.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/hed.70024","type":"journal-article","created":{"date-parts":[[2025,9,10]],"date-time":"2025-09-10T10:17:31Z","timestamp":1757499451000},"page":"438-448","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Hypoglossal Neuropathy in the Pathogenesis of Fibrosis\u2010Related Late\u2010Radiation Associated Dysphagia: A Correlative Analysis Utilizing Electromyography to Explore the Frequency of Clinical and Subclinical Neuropathy in a Pilot Dysphagia Trial"],"prefix":"10.1002","volume":"48","author":[{"given":"Holly","family":"McMillan","sequence":"first","affiliation":[{"name":"Department of Head and Neck Surgery The University of Texas M.D. Anderson Cancer Center  Houston Texas USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Christine","family":"Okoro","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology The University of Texas M.D. Anderson Cancer Center  Houston Texas USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sheila","family":"Buoy","sequence":"additional","affiliation":[{"name":"Department of Head and Neck Surgery The University of Texas M.D. Anderson Cancer Center  Houston Texas USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Karin","family":"Woodman","sequence":"additional","affiliation":[{"name":"Department of Neuro\u2010Oncology The University of Texas M.D. Anderson Cancer Center  Houston Texas USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nicolaas","family":"Anderson","sequence":"additional","affiliation":[{"name":"Department of Neurology Baylor College of Medicine  Houston Texas USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5264-3994","authenticated-orcid":false,"given":"Clifton","family":"Fuller","sequence":"additional","affiliation":[{"name":"Department of Head and Neck Surgery The University of Texas M.D. Anderson Cancer Center  Houston Texas USA"},{"name":"Department of Radiation Oncology The University of Texas M.D. Anderson Cancer Center  Houston Texas USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Stephen Y.","family":"Lai","sequence":"additional","affiliation":[{"name":"Department of Head and Neck Surgery The University of Texas M.D. Anderson Cancer Center  Houston Texas USA"},{"name":"Department of Radiation Oncology The University of Texas M.D. Anderson Cancer Center  Houston Texas USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Katherine","family":"Hutcheson","sequence":"additional","affiliation":[{"name":"Department of Head and Neck Surgery The University of Texas M.D. Anderson Cancer Center  Houston Texas USA"},{"name":"Department of Radiation Oncology The University of Texas M.D. Anderson Cancer Center  Houston Texas USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2025,9,10]]},"reference":[{"key":"e_1_2_10_2_1","doi-asserted-by":"publisher","DOI":"10.1002\/cncr.27631"},{"key":"e_1_2_10_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.oraloncology.2014.05.003"},{"key":"e_1_2_10_4_1","volume-title":"Medical Microbiology","author":"Baron S. P. I. S. B. E.","year":"1996"},{"key":"e_1_2_10_5_1","doi-asserted-by":"publisher","DOI":"10.1002\/hed.27692"},{"key":"e_1_2_10_6_1","doi-asserted-by":"publisher","DOI":"10.1002\/hed.24789"},{"key":"e_1_2_10_7_1","doi-asserted-by":"publisher","DOI":"10.3857\/roj.2014.32.3.103"},{"key":"e_1_2_10_8_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00455\u2010016\u20109710\u20101"},{"key":"e_1_2_10_9_1","doi-asserted-by":"publisher","DOI":"10.3857\/roj.2020.00913"},{"key":"e_1_2_10_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.oraloncology.2020.104853"},{"key":"e_1_2_10_11_1","doi-asserted-by":"publisher","DOI":"10.1002\/hed.25923"},{"key":"e_1_2_10_12_1","doi-asserted-by":"publisher","DOI":"10.1055\/s\u20100028\u20101124022"},{"key":"e_1_2_10_13_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.oraloncology.2019.05.014"},{"key":"e_1_2_10_14_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamaoto.2020.5269"},{"key":"e_1_2_10_15_1","doi-asserted-by":"publisher","DOI":"10.1186\/s40463\u2010022\u201000593\u20107"},{"key":"e_1_2_10_16_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.clinph.2012.08.013"},{"key":"e_1_2_10_17_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen\u20102020\u2010047830"},{"key":"e_1_2_10_18_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamaoto.2024.5157"},{"key":"e_1_2_10_19_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ncl.2021.06.003"},{"key":"e_1_2_10_20_1","volume-title":"Common Terminology Criteria for Adverse Events (CTCAE) Version 5.0 U.S","year":"2017"},{"key":"e_1_2_10_21_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejon.2014.07.006"},{"key":"e_1_2_10_22_1","doi-asserted-by":"publisher","DOI":"10.1002\/hed.28062"},{"key":"e_1_2_10_23_1","doi-asserted-by":"publisher","DOI":"10.1002\/cncr.30283"},{"key":"e_1_2_10_24_1","doi-asserted-by":"publisher","DOI":"10.1002\/1097\u20100142(19900801)66:3<564::aid\u2010cncr2820660326>3.0.co;2\u2010d"},{"key":"e_1_2_10_25_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00455\u2010014\u20109534\u20109"},{"issue":"7","key":"e_1_2_10_26_1","first-page":"870","article-title":"The Development and Validation of a Dysphagia\u2010Specific Quality\u2010Of\u2010Life Questionnaire for Patients With Head and Neck Cancer: The M. D. Anderson Dysphagia Inventory","volume":"127","author":"Chen A. Y.","year":"2001","journal-title":"Archives of Otolaryngology \u2013 Head & Neck Surgery"},{"key":"e_1_2_10_27_1","doi-asserted-by":"publisher","DOI":"10.1002\/1097\u20100142(20001001)89:7<1634::aid\u2010cncr29>3.0.co;2\u2010v"},{"key":"e_1_2_10_28_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00520\u2010011\u20101294\u20106"},{"key":"e_1_2_10_29_1","doi-asserted-by":"publisher","DOI":"10.1126\/scitranslmed.abq5585"},{"key":"e_1_2_10_30_1","unstructured":"N.Schaen\u2010Heacock \u201cHypoglossal Nerve Inflammation in a Translational Model of Chemoradiotherapy: A Pilot Study \u201d2025Presented at: Dysphagia Research Society; Philadelphia PA."},{"key":"e_1_2_10_31_1","unstructured":"S.King \u201cSelective Myelin Protein Dysregulation in Hypoglossal Nerve Following Chemoradiation Treatment \u201d2025Presented at: Dysphagia Research Society; Philadelphia PA."},{"key":"e_1_2_10_32_1","doi-asserted-by":"publisher","DOI":"10.1016\/s0891\u20105849(03)00211\u20109"},{"key":"e_1_2_10_33_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.clnesp.2022.09.022"},{"key":"e_1_2_10_34_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jfma.2021.06.020"},{"key":"e_1_2_10_35_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijrobp.2008.04.048"},{"key":"e_1_2_10_36_1","doi-asserted-by":"publisher","DOI":"10.4081\/ni.2014.5208"}],"container-title":["Head &amp; Neck"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/hed.70024","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/hed.70024","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/hed.70024","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,1,28]],"date-time":"2026-01-28T09:07:49Z","timestamp":1769591269000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/hed.70024"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,9,10]]},"references-count":35,"journal-issue":{"issue":"2","published-print":{"date-parts":[[2026,2]]}},"alternative-id":["10.1002\/hed.70024"],"URL":"https:\/\/doi.org\/10.1002\/hed.70024","archive":["Portico"],"relation":{},"ISSN":["1043-3074","1097-0347"],"issn-type":[{"value":"1043-3074","type":"print"},{"value":"1097-0347","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,9,10]]},"assertion":[{"value":"2025-05-12","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-08-23","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-09-10","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}