Importance of Tubercle of Zuckerkandl in Thyroid Surgery

Abstract

Aim and objective: To study the incidence, grading, classification of Zuckerkandl tubercle and its relation to recurrent laryngeal nerve during thyroid surgery. Methodology: A prospective study was carried out on 50 patients undergoing thyroidectomy between 17-58 years of age in the Department of General Surgery of SCB Medical College and Hospital, Cuttack during the period from july 2014 to January 2016. All the patients were subjected to detailed history taking followed by thorough clinical examination. Patients were investigated by routine biochemical test, Thyroid Function Test (TFT), Ultrasound (USG) of neck, X-Ray of neck, X-Ray of chest, fine needle aspiration and cytology (FNAC). In some cases CT Scan of neck was done. Surgical anatomy was evaluated and documented in each case. Zuckerkandl Tubercle (ZT) was dissected and its relation with recurrent laryngeal nerve(RLN) was determined. Results: There were 34 female and 16 male patients. Out of 50 cases we have 16 no. Of total thyroidectomies, 20 right hemithyroidectomies and 14 left hemithyroidectomies. ZT was identified in 34 cases, 20 on right lobe and 14 on left lobe. Out of 16 total thyroidectomy 8 had bilateral ZT, 2 right ZT and 2 left ZT. Out of 20 right hemithyroidectomy 12 had right ZT. Out of 14 left hemithyroidectomy 10 had left ZT. Conclusion: Recurrent Laryngeal Nerve was identified with the help of inferior thyroid artery(ITA) and Zuckerkandl tubercle in 68% of cases for safety. RLN could be safeguarded with the help of of ZT in this series of cases along with ITA. KEY WORD: Zuckerkandl’s tubercle, Recurrent Laryngeal Nerve, Thyroidectomy, Inferior thyroid artery.