{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T04:11:30Z","timestamp":1790136690342,"version":"4.0.1"},"reference-count":29,"publisher":"Wiley","issue":"8","license":[{"start":{"date-parts":[[2015,5,22]],"date-time":"2015-05-22T00:00:00Z","timestamp":1432252800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["The Laryngoscope"],"published-print":{"date-parts":[[2015,8]]},"abstract":"<jats:sec><jats:title>Objectives\/Hypothesis<\/jats:title><jats:p>Thermal injury to the recurrent laryngeal nerve (RLN) may not be visually apparent and may go unrecognized intraoperatively. This study aimed to investigate the heat thermal tolerance of RLN and evaluate the electrophysiologic correlates of electromyographic (EMG) signal change during an acute RLN heat damage.<\/jats:p><\/jats:sec><jats:sec><jats:title>Study Design<\/jats:title><jats:p>Prospective porcine model with continuous intraoperative neuromonitoring (CIONM).<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Ten pigs (20 RLNs) undergoing CIONM had their EMG tracings recorded and correlated with heated normal saline (NS) irrigation of varying temperature and duration.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>In the initial pilot study, the EMG was without change during incremental heated NS irrigation (40\/45\/50\/55 \u00b0C for 60 seconds), but adverse EMG combined events (CE) (amplitude decrease with a concordant latency increase) occurred and degraded to loss of signal (LOS) (by 17.5\u2009\u00b1\u20091.3 seconds) when the temperature was elevated to 60 \u00b0C (n\u2009=\u20094). Another 16 RLNs were evaluated to further compare the EMG pattern after various degrees of thermal stress (60\/70 \u00b0C for 30\/20 seconds). Electromyographic recordings showed CEs and LOS in all RLNs, and only six of eight RLNs with 60 \u00b0C exposure showed slight EMG amplitude recovery (16%\u201335%) after 20 minutes. None of the injured nerve segments were visually apparent, but all were detectable by IONM.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Sixty degrees Celsius is a critical temperature to cause RLN thermal injury. Continuous intraoperative neuromonitoring can be used as a tool for the early detection of acute thermal stress and may guide use of energy\u2010based devices during thyroid procedures.<\/jats:p><\/jats:sec><jats:sec><jats:title>Level of Evidence<\/jats:title><jats:p>N\/A. <jats:italic>Laryngoscope<\/jats:italic>, 125:E283\u2013E290, 2015<\/jats:p><\/jats:sec>","DOI":"10.1002\/lary.25362","type":"journal-article","created":{"date-parts":[[2015,5,22]],"date-time":"2015-05-22T12:59:15Z","timestamp":1432299555000},"source":"Crossref","is-referenced-by-count":58,"title":["Electrophysiologic monitoring correlates of recurrent laryngeal nerve heat thermal injury in a porcine model"],"prefix":"10.1002","volume":"125","author":[{"given":"Yi\u2010Chu","family":"Lin","sequence":"first","affiliation":[{"name":"Graduate Institute of Clinical Medicine, Faculty of Medicine, College of Medicine, Department of Otorhinolaryngology\u2013Head and Neck Surgery  Kaohsiung 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