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Thyroid tubercle of Zuckerkandl: anatomical and surgical experience from 79 thyroidectomies

Published online by Cambridge University Press:  12 November 2008

C Page*
Affiliation:
Department of Anatomy, School of Medicine, Jules Verne University of Picardie, Amiens, France Department of ENT and Head and Neck Surgery, Amiens University Hospital, France
P Cuvelier
Affiliation:
Department of ENT and Head and Neck Surgery, Amiens University Hospital, France
A Biet
Affiliation:
Department of ENT and Head and Neck Surgery, Amiens University Hospital, France
P Boute
Affiliation:
Department of ENT and Head and Neck Surgery, Amiens University Hospital, France
M Laude
Affiliation:
Department of Anatomy, School of Medicine, Jules Verne University of Picardie, Amiens, France
V Strunski
Affiliation:
Department of ENT and Head and Neck Surgery, Amiens University Hospital, France
*
Address for correspondence: Dr Cyril Page, CHU d'Amiens, Hôpital Nord, Service d'ORL et de Chirurgie Cervico-Faciale, F-80054 Amiens Cédex, France. E-mail: cyril.page@caramail.com

Abstract

Objective:

To highlight a poorly known anatomical variation of the lateral lobe of the thyroid gland, which can be useful in identifying the recurrent laryngeal nerve during thyroid surgery.

Materials and methods:

We performed a three-year prospective study of 79 thyroid surgery patients. Great attention was paid to anatomical variations of the thyroid gland (i.e. the presence or absence of a distinct tubercle of Zuckerkandl), the recurrent laryngeal nerve and the location of the parathyroid glands.

Results:

A total of 71 right lobectomies and 74 left lobectomies were performed. Five tubercles of Zuckerkandl were identified (7.04 per cent of cases) and were useful in detecting the recurrent laryngeal nerve (but only on the right side).

Conclusion:

The tubercle of Zuckerkandl is a poorly known and variable anatomical feature of the thyroid gland which may not, in fact, be so rare. It arises for embryological reasons, and it can be a reliable anatomical landmark for identifying the recurrent laryngeal nerve during thyroid surgery. It should be included in the Nomina Anatomica as the ‘processus posterior glandulae thyroideae’ described by Zuckerkandl.

Type
Main Articles
Copyright
Copyright © JLO (1984) Limited 2008

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References

1 Chevallier, JM, Martelli, H, Wind, P. Surgical discovery of parathyroid glands and the recurrent laryngeal nerve. Application of well known embryological concepts in the operating room [in French]. Ann Chir 1995;49:296304Google ScholarPubMed
2 Chiang, FY, Wang, LF, Huang, YF, Lee, KW, Kuo, WR. Recurrent laryngeal nerve palsy after thyroidectomy with routine identification of the recurrent laryngeal nerve. Surgery 2005;137:342–7CrossRefGoogle ScholarPubMed
3 Gauger, PG, Delbridge, LW, Thompson, NW, Crummer, P, Reeve, TS. Incidence and importance of the tubercle of Zuckerkandl in thyroid surgery. Eur J Surg 2001;167:249–54Google ScholarPubMed
4 Gemsenjäger, EW, Schweizer, I. Zuckerkandl's tuberculum in thyroid surgery. J Am Coll Surg 1999;188:336–7Google ScholarPubMed
5 Hisham, AN, Aina, EN. Zuckerkandl's tubercle of the thyroid gland in association with pressure symptoms: a coincidence or consequence? Aust N Z J Surg 2000;70:251–3CrossRefGoogle ScholarPubMed
6 Karlan, MS, Catz, B, Dunkelman, D, Uyeda, RY, Gleishman, S. A safe technique for thyroidectomy with complete nerve dissection and parathyroid preservation. Head Neck Surg 1984;6:1014–19CrossRefGoogle ScholarPubMed
7 Kocak, S, Aydintug, S. Zuckerkandl's tuberculum. J Am Coll Surg 2000;190:98–9Google Scholar
8 Leow, CK. Zuckerkandl's tuberculum. J Am Coll Surg 1999;188:334–6Google Scholar
9 Loré, JM Jr, Kim, DJ, Elias, S. Preservation of the laryngeal nerves during total thyroid lobectomy. Ann Otol Rhinol Laryngol 1977;86:777–88CrossRefGoogle ScholarPubMed
10 Mirilas, P, Skandalakis, JE. Zuckerkandl's tubercle: Hannibal ad Portas. J Am Coll Surg 2003;196:796801Google Scholar
11 Organ, GM, Organ, CH. Thyroid gland and surgery of the thyroglossal duct: exercise in applied embryology. World J Surg 2000;24:886–90CrossRefGoogle ScholarPubMed
12 Page, C, Peltier, J, Charlet, L, Laude, M, Strunski, V. Superior approach to the inferior laryngeal nerve in thyroid surgery: anatomy, surgical technique and indications. Surg Radiol Anat 2006;28:631–6CrossRefGoogle Scholar
13 Page, C, Foulon, P, Strunski, V. The inferior laryngeal nerve: surgical and anatomic considerations. Report of 251 thyroidectomies. Surg Radiol Anat 2003;25:188–91CrossRefGoogle ScholarPubMed
14 Pelizzo, MR, Toniato, A, Gemo, G. Zuckerkandl's tuberculum: an arrow pointing to the recurrent laryngeal nerve (constant anatomical landmark). J Am Coll Surg 1998;187:333–6CrossRefGoogle Scholar
15 Riddell, VH. Injury to recurrent laryngeal nerves during thyroidectomy; a comparison between the results of identification and non-identification in 1022 nerves exposed to risk. Lancet 1956;271:638–41CrossRefGoogle ScholarPubMed
16 Sturniolo, G, D'Alia, C, Tonante, A, Gagliano, E, Taranto, F, Lo Schiavo, MG. The recurrent laryngeal nerve related to thyroid surgery. Am J Surg 1999;177:485–8CrossRefGoogle ScholarPubMed
17 Wang, C. The use of the inferior cornu of the thyroid cartilage in identifying the recurrent laryngeal nerve. Surg Gynecol Obstet 1975;140:91–4Google ScholarPubMed
18 Younes, NA, Bradan, DH. The cricothyroid space: a guide for successful thyroidectomy. Asian J Surg 2002;25:226–31CrossRefGoogle ScholarPubMed