{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,7]],"date-time":"2026-07-07T14:11:44Z","timestamp":1783433504203,"version":"3.54.6"},"reference-count":22,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2016,7,4]],"date-time":"2016-07-04T00:00:00Z","timestamp":1467590400000},"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":[[2017,3]]},"abstract":"<jats:sec><jats:title>Objectives\/Hypothesis<\/jats:title><jats:p>Correlation of physiologically important electromyographic (EMG) waveforms with demonstrable muscle activation is important for the reliable interpretation of evoked waveforms during intraoperative neural monitoring (IONM) of the vagus nerve, recurrent laryngeal nerve (RLN), and external branch of the superior laryngeal nerve (EBSLN) in thyroid surgery.<\/jats:p><\/jats:sec><jats:sec><jats:title>Study Design<\/jats:title><jats:p>Retrospective chart review.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Data were reviewed retrospectively for thyroid surgery patients with laryngeal nerve IONM from January to December, 2015. EMG responses to monopolar stimulation of the vagus\/RLN and EBSLN were recorded in bilateral vocalis, cricothyroid (CTM), and strap muscles using endotracheal tube\u2010based surface and intramuscular hook electrodes, respectively. Target muscles for vagal\/RLN and EBSLN stimulation were the ipsilateral vocalis and CTM, respectively. All other recording channels were nontarget muscles.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Fifty surgical sides were identified in 37 subjects. All target muscle mean amplitudes were significantly higher than in nontarget muscles. With vagal\/RLN stimulation, target ipsilateral vocalis mean amplitude was 1,095.7 \u03bcV (mean difference range = \u2212814.1 to \u22121,078 \u03bcV, <jats:italic>P<\/jats:italic> &lt; .0001). For EBSLN stimulation, target ipsilateral CTM mean amplitude was 6,379.3 \u03bcV (mean difference range = \u22126,222.6 to \u22126,362.3 \u03bcV, <jats:italic>P<\/jats:italic> &lt; .0001). Target muscle large\u2010amplitude EMG responses correlated with meaningful visual or palpable muscular responses, whereas nontarget EMG responses showed no meaningful muscle activation.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Target and nontarget laryngeal muscles are differentiated based on divergence of EMG response directly correlating with presence or absence of visual and palpable muscle activation. Low\u2010amplitude EMG waveforms in nontarget muscles with neural stimulation can be explained by the concept of far\u2010field artifactual waveforms and do not correspond to a true muscular response. The surgeon should be aware of these nonphysiologic waveforms when interpreting and applying IONM during thyroid surgery.<\/jats:p><\/jats:sec><jats:sec><jats:title>Level of Evidence<\/jats:title><jats:p>4 <jats:italic>Laryngoscope<\/jats:italic>, 127:764\u2013771, 2017<\/jats:p><\/jats:sec>","DOI":"10.1002\/lary.26147","type":"journal-article","created":{"date-parts":[[2016,7,4]],"date-time":"2016-07-04T08:15:56Z","timestamp":1467620156000},"page":"764-771","source":"Crossref","is-referenced-by-count":37,"title":["The electrophysiology of thyroid surgery: electrophysiologic and muscular responses with stimulation of the vagus nerve, recurrent laryngeal nerve, and external branch of the superior laryngeal nerve"],"prefix":"10.1002","volume":"127","author":[{"given":"Whitney","family":"Liddy","sequence":"first","affiliation":[{"name":"Division of Thyroid and Parathyroid Endocrine Surgery Department of Otolaryngology Massachusetts Eye and Ear Infirmary Boston Massachusetts U.S.A"},{"name":"Department of Otology and Laryngology Harvard Medical School Boston Massachusetts U.S.A"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Samuel R.","family":"Barber","sequence":"additional","affiliation":[{"name":"Division of Thyroid and Parathyroid Endocrine Surgery Department of Otolaryngology Massachusetts Eye and Ear Infirmary Boston Massachusetts U.S.A"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matteo","family":"Cinquepalmi","sequence":"additional","affiliation":[{"name":"Division of Thyroid and Parathyroid Endocrine Surgery Department of Otolaryngology Massachusetts Eye and Ear Infirmary Boston Massachusetts U.S.A"},{"name":"Surgery of Thyroid and Parathyroid Operative Unit Sapienza University of Rome, S. Andrea Hospital Rome Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brian M.","family":"Lin","sequence":"additional","affiliation":[{"name":"Division of Thyroid and Parathyroid Endocrine Surgery Department of Otolaryngology Massachusetts Eye and Ear Infirmary Boston Massachusetts U.S.A"},{"name":"Department of Otology and Laryngology Harvard Medical School Boston Massachusetts U.S.A"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stephanie","family":"Patricio","sequence":"additional","affiliation":[{"name":"Division of Thyroid and Parathyroid Endocrine Surgery Department of Otolaryngology Massachusetts Eye and Ear Infirmary Boston Massachusetts U.S.A"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Natalia","family":"Kyriazidis","sequence":"additional","affiliation":[{"name":"Division of Thyroid and Parathyroid Endocrine Surgery Department of Otolaryngology Massachusetts Eye and Ear Infirmary Boston Massachusetts U.S.A"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carlo","family":"Bellotti","sequence":"additional","affiliation":[{"name":"Surgery of Thyroid and Parathyroid Operative Unit Sapienza University of Rome, S. Andrea Hospital Rome Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dipti","family":"Kamani","sequence":"additional","affiliation":[{"name":"Division of Thyroid and Parathyroid Endocrine Surgery Department of Otolaryngology Massachusetts Eye and Ear Infirmary Boston Massachusetts U.S.A"},{"name":"Department of Otology and Laryngology Harvard Medical School Boston Massachusetts U.S.A"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sadhana","family":"Mahamad","sequence":"additional","affiliation":[{"name":"Division of Thyroid and Parathyroid Endocrine Surgery Department of Otolaryngology Massachusetts Eye and Ear Infirmary Boston Massachusetts U.S.A"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Henning","family":"Dralle","sequence":"additional","affiliation":[{"name":"Department of General Visceral, and Vascular Surgery, Martin Luther University Halle\u2010Wittenberg Halle (Saale) Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rick","family":"Schneider","sequence":"additional","affiliation":[{"name":"Department of General Visceral, and Vascular Surgery, Martin Luther University Halle\u2010Wittenberg Halle (Saale) Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gianlorenzo","family":"Dionigi","sequence":"additional","affiliation":[{"name":"Endocrine Surgery Research Center Department of Surgical Sciences, University of Insubria Varese Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marcin","family":"Barczynski","sequence":"additional","affiliation":[{"name":"Department of Endocrine Surgery Jagiellonian University College of Medicine Krakow Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Che\u2010Wei","family":"Wu","sequence":"additional","affiliation":[{"name":"Department of Otorhinolaryngology\u2013Head and Neck Surgery Kaohsiung Medical University Hospital, Faculty of Medicine, College of Medicine, Kaohsiung Medical University Kaohsiung Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Feng Yu","family":"Chiang","sequence":"additional","affiliation":[{"name":"Department of Otorhinolaryngology\u2013Head and Neck Surgery Kaohsiung Medical University Hospital, Faculty of Medicine, College of Medicine, Kaohsiung Medical University Kaohsiung Taiwan"},{"name":"Institute of Clinical Medicine, Kaohsiung Medical University Kaohsiung Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gregory","family":"Randolph","sequence":"additional","affiliation":[{"name":"Division of Thyroid and Parathyroid Endocrine Surgery Department of Otolaryngology Massachusetts Eye and Ear Infirmary Boston Massachusetts U.S.A"},{"name":"Department of Otology and Laryngology Harvard Medical School Boston Massachusetts U.S.A"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2016,7,4]]},"reference":[{"key":"e_1_2_6_2_1","first-page":"306","volume-title":"Surgery of the Thyroid and Parathyroid Glands","author":"Randolph G","year":"2013"},{"key":"e_1_2_6_3_1","doi-asserted-by":"publisher","DOI":"10.1002\/lary.21119"},{"key":"e_1_2_6_4_1","doi-asserted-by":"publisher","DOI":"10.1002\/lary.24301"},{"key":"e_1_2_6_5_1","unstructured":"RandolphG.Intraoperative electrophysiologic monitoring of the recurrent laryngeal nerve during thyroid and parathyroid surgery: experience with 1381 nerves at risk. 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