Abstract
to evaluate whether the lateral projection of the thyroid gland, called Zuckerkandl's tubercle (ZT), can assist the surgeon in identifying the inferior laryngeal nerve during conventional open thyroidectomy. we conducted a prospective study with 51 patients submitted to thyroidectomy, with a total of 100 resected thyroid lobes, and observed the presence or absence of ZT in sufficient dimensions to be identified without image magnification, its base and height, its location in the gland, and its anatomical relationship with the inferior laryngeal nerve. ZT was present in 68 of the 100 thyroid lobes analyzed (68%). The mean base was 6.7mm on the right side and 7.1mm on the left side, and the average height was 5.7mm on the right side and 6.1mm on the left side. In most of the lobes studied, the tubercle had a minimum height of 5mm (55.9%), with no significant difference between the right and left lobes of the thyroid gland. During surgery, 100% of the identified ZTs were anterior to the inferior laryngeal nerve, just below the nerve entry in the larynx. the ZT is a quite frequent entity and large enough to serve as an intraoperative anatomical reference for the inferior laryngeal nerve, next to its entry in the larynx, along with other anatomical references.
Highlights
The Zuckerkandl’s tubercle (ZT), described in 1867 by Madelung[1] and popularized in 1902 by the Austrian anatomist Emil Zuckerkandl (1849-1910)[2], is a posterolateral projection of the thyroid lobes, formed during the gland’s embryogenesis, indicating the point of fusion between the last branchial body and the main median thyroid process[3,4].The inferior laryngeal nerve (ILN) is the terminal branch of the recurrent nerve, which in turn is a branch of the vagus nerve
We conducted a prospective study of 51 consecutive patients submitted to conventional open thyroidectomy, with a total of 100 resected thyroid lobes, and observation of the presence or absence of ZT in sufficient dimensions to be identified without image magnification
The Zuckerkandl's tubercle was described over a century ago. It is little used as a reference in the location of the inferior laryngeal nerve
Summary
The Zuckerkandl’s tubercle (ZT), described in 1867 by Madelung[1] and popularized in 1902 by the Austrian anatomist Emil Zuckerkandl (1849-1910)[2], is a posterolateral projection of the thyroid lobes, formed during the gland’s embryogenesis, indicating the point of fusion between the last branchial body and the main median thyroid process[3,4].The inferior laryngeal nerve (ILN) is the terminal branch of the recurrent nerve, which in turn is a branch of the vagus nerve. The ILN follows a different path in each side. On the right, it runs beneath the right subclavian artery on the upper chest, and on the left, it contours the aortic arch, having a much longer course within the mediastinum. It runs beneath the right subclavian artery on the upper chest, and on the left, it contours the aortic arch, having a much longer course within the mediastinum Both run through the tracheoesophageal groove, pass between the thyroid, the trachea and the esophagus, and enter the larynx[5]. The appropriate way to avoid ILN injuries during thyroidectomy is its careful identification and dissection until its entry into the larynx[7], and a good knowledge of its anatomical relationship with the ZT may contribute to this identification[8]
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