{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,20]],"date-time":"2025-10-20T14:10:39Z","timestamp":1760969439323,"version":"build-2065373602"},"reference-count":4,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2019,3,12]],"date-time":"2019-03-12T00:00:00Z","timestamp":1552348800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["aao-hnsfjournals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Otolaryngol.--head neck surg."],"published-print":{"date-parts":[[2019,7]]},"abstract":"<jats:sec><jats:title>Objective<\/jats:title><jats:p>The laryngeal adductor reflex (LAR) is an airway\u2010protective response triggered by sensory laryngeal receptors and resulting in bilateral vocal fold adduction. The normal morphology of the early R1 response resembles that of the compound muscle action potential (CMAP). However, in a small subset of patients, the morphology is dyssynchronous with multiple peaks. This study investigates whether preoperative LAR dyssynchrony predicts intraoperative nerve behavior during thyroid surgeries.<\/jats:p><\/jats:sec><jats:sec><jats:title>Study Design<\/jats:title><jats:p>Retrospective case\u2010control study.<\/jats:p><\/jats:sec><jats:sec><jats:title>Setting<\/jats:title><jats:p>US academic health center.<\/jats:p><\/jats:sec><jats:sec><jats:title>Subjects and Methods<\/jats:title><jats:p>Opening and closing LAR waveforms from 200 patients with normal preoperative laryngeal examinations monitored continuously during thyroid surgeries using the LAR were analyzed. Area under the curve (AUC) and number of \u201cevents\u201d during surgery (defined as any transient decline in AUC &gt;50% baseline) were determined for patients who demonstrated opening dyssynchronous LAR traces compared to demographically matched controls.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Six patients had opening dyssynchronous LAR traces. These patients had significantly greater declines in R1 AUC than demographically matched patients with opening synchronized R1 traces (<jats:italic>P<\/jats:italic> =. 007). Upon thyroid removal, 1 patient converted from a dyssynchronous to synchronous trace.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Preincision dyssynchronous LAR waveforms may indicate subclinical, potentially reversible, neuropathy of the recurrent laryngeal nerve (RLN) and predict intraoperative RLN behavior. Preincision knowledge of R1 dyssynchrony can facilitate surgical planning as such patients may glean particular benefit from <jats:italic>continuous<\/jats:italic> intraoperative nerve monitoring, frequent tissue relaxation, and saline irrigation as means to minimize nerve stress intraoperatively.<\/jats:p><\/jats:sec>","DOI":"10.1177\/0194599819835781","type":"journal-article","created":{"date-parts":[[2019,3,12]],"date-time":"2019-03-12T04:21:49Z","timestamp":1552364509000},"page":"118-122","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Continuous Vagal Neuromonitoring Using the Laryngeal Adductor Reflex: Can Preincision Dyssynchrony Predict Intraoperative Nerve Behavior?"],"prefix":"10.1002","volume":"161","author":[{"given":"Maria De Los Angeles Sanchez","family":"Roldan","sequence":"first","affiliation":[{"name":"Department of Intraoperative Neurophysiology Mount Sinai West Hospital New York New York USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Maria J.","family":"T\u00e9llez","sequence":"additional","affiliation":[{"name":"Department of Intraoperative Neurophysiology Mount Sinai West Hospital New York New York USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sedat","family":"Ulkatan","sequence":"additional","affiliation":[{"name":"Department of Intraoperative Neurophysiology Mount Sinai West Hospital New York New York USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Catherine F.","family":"Sinclair","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2013Head and Neck Surgery Mount Sinai West Hospital New York New York USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2019,3,12]]},"reference":[{"key":"e_1_2_8_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.clinph.2017.03.002"},{"key":"e_1_2_8_3_1","doi-asserted-by":"publisher","DOI":"10.1002\/hed.25377"},{"key":"e_1_2_8_4_1","first-page":"1","article-title":"Acute nerve compression and the compound muscle action potential","volume":"3","author":"Stecker MM","year":"2008","journal-title":"J Brachial Plex Peripher Nerve Inj"},{"key":"e_1_2_8_5_1","first-page":"4","article-title":"Acute nerve stretch and the compound motor action potential","volume":"6","author":"Stecker MM","year":"2011","journal-title":"J Brachial Plex Peripher Nerve Inj"}],"container-title":["Otolaryngology\u2013Head and Neck Surgery"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1177\/0194599819835781","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1177\/0194599819835781","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/aao-hnsfjournals.onlinelibrary.wiley.com\/doi\/pdf\/10.1177\/0194599819835781","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,20]],"date-time":"2025-10-20T13:52:04Z","timestamp":1760968324000},"score":1,"resource":{"primary":{"URL":"https:\/\/aao-hnsfjournals.onlinelibrary.wiley.com\/doi\/10.1177\/0194599819835781"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2019,3,12]]},"references-count":4,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2019,7]]}},"alternative-id":["10.1177\/0194599819835781"],"URL":"https:\/\/doi.org\/10.1177\/0194599819835781","archive":["Portico"],"relation":{},"ISSN":["0194-5998","1097-6817"],"issn-type":[{"type":"print","value":"0194-5998"},{"type":"electronic","value":"1097-6817"}],"subject":[],"published":{"date-parts":[[2019,3,12]]},"assertion":[{"value":"2018-11-07","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2019-02-14","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2019-03-12","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}