{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,25]],"date-time":"2026-09-25T02:58:39Z","timestamp":1790305119152,"version":"4.1.0"},"reference-count":29,"publisher":"Wiley","license":[{"start":{"date-parts":[[2026,9,24]],"date-time":"2026-09-24T00:00:00Z","timestamp":1790208000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,9,24]],"date-time":"2026-09-24T00:00:00Z","timestamp":1790208000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/501100011645","name":"Kaohsiung Medical University Chung-Ho Memorial Hospital","doi-asserted-by":"publisher","award":["KMUH 113\u20103R47"],"award-info":[{"award-number":["KMUH 113\u20103R47"]}],"id":[{"id":"10.13039\/501100011645","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100011645","name":"Kaohsiung Medical University Chung-Ho Memorial Hospital","doi-asserted-by":"publisher","award":["KMUH 114\u20104R52"],"award-info":[{"award-number":["KMUH 114\u20104R52"]}],"id":[{"id":"10.13039\/501100011645","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Head &amp; Neck"],"abstract":"ABSTRACT<\/jats:title>\n \n Background<\/jats:title>\n Tissue exposure to cold temperatures is common in clinical practice, yet the safety of exposing the recurrent laryngeal nerve (RLN) to cold remains unclear. This study evaluated temperature\u2010dependent effects of cold exposure on RLN function.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n A porcine continuous intraoperative neuromonitoring (C\u2010IONM) model was used to assess electromyographic (EMG) changes in 16 RLNs exposed to four temperature conditions: room temperature water, cold water, ice water, and ice block. Each exposure lasted 1\u2009min, followed by 20\u2009min of EMG monitoring.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n Room temperature and cold water caused no or only mild EMG changes with complete recovery. Ice water induced moderate to severe disturbances with partial reversibility. Ice block exposure produced the most severe effects, including transient loss of signal and incomplete recovery in some nerves.<\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n Cold exposure below 3\u00b0C can induce significant RLN dysfunction. These findings provide evidence that near\u2010freezing temperatures, presumed to be neuroprotective, instead carry a distinct risk of iatrogenic neural injury, underscoring the need for caution in clinical applications.<\/jats:p>\n <\/jats:sec>","DOI":"10.1002\/hed.70489","type":"journal-article","created":{"date-parts":[[2026,9,25]],"date-time":"2026-09-25T02:05:32Z","timestamp":1790301932000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Cold Exposure to the Recurrent Laryngeal Nerve: A Porcine Continuous Intraoperative Neuromonitoring Model Study"],"prefix":"10.1002","author":[{"given":"Tzu\u2010Yen","family":"Huang","sequence":"first","affiliation":[{"name":"Department of Otolaryngology\u2010Head and Neck Surgery, Kaohsiung Medical University Hospital Kaohsiung Medical University Kaohsiung Taiwan"},{"name":"Department of Otolaryngology\u2010Head and Neck Surgery Kaohsiung Medical University Gangshan Hospital Kaohsiung Medical University Kaohsiung Taiwan"},{"name":"School of Post\u2010Baccalaureate Medicine and School of Medicine, College of Medicine Kaohsiung Medical University Kaohsiung Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4066-9465","authenticated-orcid":false,"given":"Hsin\u2010Yi","family":"Tseng","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2010Head and Neck Surgery, Kaohsiung Medical University Hospital Kaohsiung Medical University Kaohsiung Taiwan"},{"name":"Department of Otolaryngology\u2010Head and Neck Surgery Kaohsiung Medical University Gangshan Hospital Kaohsiung Medical University Kaohsiung Taiwan"},{"name":"School of Post\u2010Baccalaureate Medicine and School of Medicine, College of Medicine Kaohsiung Medical University Kaohsiung Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yi\u2010Chu","family":"Lin","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2010Head and Neck Surgery, Kaohsiung Medical University Hospital Kaohsiung Medical University Kaohsiung Taiwan"},{"name":"Department of Otolaryngology\u2010Head and Neck Surgery Kaohsiung Medical University Gangshan Hospital Kaohsiung Medical University Kaohsiung Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gregory W.","family":"Randolph","sequence":"additional","affiliation":[{"name":"Division of Thyroid and Parathyroid Endocrine Surgery, Department of Otolaryngology\u2014Head and Neck Surgery, Massachusetts Eye and Ear Infirmary Harvard Medical School Boston Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marika","family":"Russell","sequence":"additional","affiliation":[{"name":"Division of Thyroid and Parathyroid Endocrine Surgery, Department of Otolaryngology\u2014Head and Neck Surgery, Massachusetts Eye and Ear Infirmary Harvard Medical School Boston Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5611-5833","authenticated-orcid":false,"given":"Amr H. Abdelhamid","family":"Ahmed","sequence":"additional","affiliation":[{"name":"Division of Thyroid and Parathyroid Endocrine Surgery, Department of Otolaryngology\u2014Head and Neck Surgery, Massachusetts Eye and Ear Infirmary Harvard Medical School Boston Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"I\u2010Cheng","family":"Lu","sequence":"additional","affiliation":[{"name":"School of Post\u2010Baccalaureate Medicine and School of Medicine, College of Medicine Kaohsiung Medical University Kaohsiung Taiwan"},{"name":"Department of Anesthesiology, Kaohsiung Medical University Hospital Kaohsiung Medical University Kaohsiung Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chih\u2010Hung","family":"Lin","sequence":"additional","affiliation":[{"name":"School of Post\u2010Baccalaureate Medicine and School of Medicine, College of Medicine Kaohsiung Medical University Kaohsiung Taiwan"},{"name":"Department of Pathology, Kaohsiung Medical University Hospital Kaohsiung Medical University Kaohsiung Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6429-9038","authenticated-orcid":false,"given":"Cheng\u2010Hsun","family":"Chuang","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2010Head and Neck Surgery, Kaohsiung Medical University Hospital Kaohsiung Medical University Kaohsiung Taiwan"},{"name":"Department of Otolaryngology\u2010Head and Neck Surgery Kaohsiung Medical University Gangshan Hospital Kaohsiung Medical University Kaohsiung Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9168-5858","authenticated-orcid":false,"given":"Jia Joanna","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2010Head and Neck Surgery, Kaohsiung Medical University Hospital Kaohsiung Medical University Kaohsiung Taiwan"},{"name":"Department of Otolaryngology\u2010Head and Neck Surgery, Kaohsiung Municipal Siaogang Hospital Kaohsiung Medical University Kaohsiung Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Leong\u2010Perng","family":"Chan","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2010Head and Neck Surgery, Kaohsiung Medical University Hospital Kaohsiung Medical University Kaohsiung Taiwan"},{"name":"School of Post\u2010Baccalaureate Medicine and School of Medicine, College of Medicine Kaohsiung Medical University Kaohsiung Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Feng\u2010Yu","family":"Chiang","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2010Head and Neck Surgery, E\u2010Da Hospital, and School of Medicine, College of Medicine I\u2010Shou University Kaohsiung Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Li\u2010Ren","family":"Yeh","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, E\u2010Da Cancer Hospital I\u2010Shou University Kaohsiung Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1052-5348","authenticated-orcid":false,"given":"Che\u2010Wei","family":"Wu","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2010Head and Neck Surgery, Kaohsiung Medical University Hospital Kaohsiung Medical University Kaohsiung Taiwan"},{"name":"School of Post\u2010Baccalaureate Medicine and School of Medicine, College of Medicine Kaohsiung Medical University Kaohsiung Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,9,24]]},"reference":[{"issue":"1","key":"e_1_2_11_2_1","doi-asserted-by":"crossref","DOI":"10.1038\/srep18525","article-title":"Cryotherapy 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