Two Cases of Enlarged Zuckerkandl's Tubercle of the Thyroid Displacing the Recurrent Laryngeal Nerve Laterally

Emin Gurleyik

doi:10.1155/2011/303861

Abstract

The thyroid has many anatomic variations. Zuckerkandl's tubercle (ZT) is the posterior extension of lateral lobes. ZT has a relation with the recurrent laryngeal nerve (RLN). RLN lateral to ZT is an uncommon occurrence. This paper presents two cases of this uncommon situation. A 60-year-old female patient with large multinodular goiter was treated with total thyroidectomy. A 69-year-old male patient with follicular neoplasm was treated with total lobectomy. The inferior thyroid arteries and the recurrent laryngeal nerves were identified with usual lateral approach. A left ZT was found in case 1 and a right ZT in case 2. Distal parts of the RLNs were displaced laterally by enlarged ZTs in both cases. Grade 3 ZTs composed of thyroid tissue were placed between the trachea and the RLNs. The ZT is a common anatomic feature of the thyroid. Close relation of the tubercle with the RLN is an important surgical entity. The enlarged ZT seldom pushes the nerve laterally. The knowledge of the anatomy of ZT and its relation with the RLN including all variations is mandatory for safe thyroid operations.

Highlights

Surgical procedures on the thyroid gland constitute greater part of endocrine surgery
We present two patients with nodular goiter accompanied with enlarged Zuckerkandl’s tubercle (ZT) displacing recurrent laryngeal nerve (RLN) laterally
The safety of thyroid operations mainly depends on complete knowledge of the embryology, anatomy, and topography of the thyroid gland and related vascular, nervous structures and parathyroid glands including all potential variations

Summary

Introduction

Surgical procedures on the thyroid gland constitute greater part of endocrine surgery. Zuckerkandl’s tubercle (ZT) is defined as the extension of the lateral lobes of the thyroid, composing of thyroid tissue only [2] This has a relationship with the recurrent laryngeal nerve (RLN) at its distal part. An enlarged ZT (grade 3) displacing RLN may increase injury risk to the nerve during total thyroidectomy. In this case report, we present two patients with nodular goiter accompanied with enlarged ZT displacing RLNs laterally. A 60-year-old female patient with large goiter has been presented to our department with a long-term history of thyroid gland enlargement. Thyroid ultrasound showed multiple hypoechoic solid nodules in both two lobes and isthmus of the gland.

Inferior thyroid artery RLN

Findings

Discussion