The Zuckerkandl tubercle and the recurrent laryngeal nerve

Abstract

We read with interest the article by Gravante et al 1 Gravante G. Delogu D. Rizzello A. et al. The Zuckerkandl tubercle. Am J Surg. 2007; 193: 484-485 Abstract Full Text Full Text PDF PubMed Scopus (23) Google Scholar concerning the relationship between the Zuckerkandl tubercle and the recurrent laryngeal nerve. Pelizzo et al 2 Pelizzo M.R. Toniato A. Gemo G. Zuckerkandl's tuberculum: an arrow pointing to the recurrent laryngeal nerve (constant anatomical landmark). J Am Coll Surg. 1998; 187: 333-336 Abstract Full Text Full Text PDF PubMed Scopus (123) Google Scholar claimed that the tubercle might be an important anatomic landmark indicating the location of the recurrent laryngeal nerve during thyroid surgery, but others 3 Koçak S. Aydintug S. Zuckerkandl's tuberculum. J Am Coll Surg. 2000; 190: 98-99 Abstract Full Text Full Text PDF PubMed Scopus (10) Google Scholar did not agree; hence, the relationship remains controversial. Gravante et al 1 Gravante G. Delogu D. Rizzello A. et al. The Zuckerkandl tubercle. Am J Surg. 2007; 193: 484-485 Abstract Full Text Full Text PDF PubMed Scopus (23) Google Scholar stated, “Although not always present, the Zuckerkandl tubercle is an easy and simple way to localize the recurrent laryngeal nerve.” We understood from the sentence that tubercles of all grades indicated the location of the nerve. Nevertheless, it is logical, that according to the grading system 2 Pelizzo M.R. Toniato A. Gemo G. Zuckerkandl's tuberculum: an arrow pointing to the recurrent laryngeal nerve (constant anatomical landmark). J Am Coll Surg. 1998; 187: 333-336 Abstract Full Text Full Text PDF PubMed Scopus (123) Google Scholar , that grades 0 (unrecognizable) and 1 (only a thickening of the lateral lobe) tubercles cannot indicate the location of the nerve. Therefore, we used only recognizable tubercles (grades 2 and 3) to investigate the relationship 4 Yalçın B. Poyrazoğlu Y. Ozan H. Relationship between the Zuckerkandl's Tubercle and the inferior laryngeal nerve including the laryngeal branches. Surg Today. 2007; 37: 109-113 Crossref PubMed Scopus (23) Google Scholar . Although the investigators stated that the tubercle was located between the superior and inferior lobes, they did not indicate detailed knowledge about its exact anatomic location. In the study 4 Yalçın B. Poyrazoğlu Y. Ozan H. Relationship between the Zuckerkandl's Tubercle and the inferior laryngeal nerve including the laryngeal branches. Surg Today. 2007; 37: 109-113 Crossref PubMed Scopus (23) Google Scholar , we recognized that the tubercle was located not only in the middle third of the lateral lobe of the thyroid gland, at the level of the ligament of Berry, but also in the upper and lower thirds. The tubercle was located in the upper third of the thyroid gland, above the nerve, in 3.8% of sides. Therefore, the tubercle did not indicate the location of the nerve.