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Per Operative Study of Relation of Zuckerkandl Tubercle with Recurrent Laryngeal Nerve in Thyroid Surgery

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Abstract

To identify Zuckerkandl tubercle and to determine relationship between the recurrent laryngeal nerve and Zuckerkandl tubercle (ZT). Peroperative study. Intraoperatively Zuckerkandl tubercle was identified. Size of the thyroid lobe and Zuckerkandl tubercle were co-related and direction of tubercle in relation to recurrent laryngeal nerve was examined. Grading of tubercle on the basis of size was done. We studied its direction and relation with recurrent laryngeal nerve. ZT was identified in 87.86% (179 out of 206) of cases. In the study amongst the 179 cases in whom ZT could be identified, ZT was found on the right side (85.41% i.e. 123 out of 144), 81.41% (92 out of 113) to the left side and 15.68% (8 out of 51) were B/L. ZT was found posterior to the tubercle in 97.22%(175 out of 179) cases and anterior to the tubercle in 2.77% (5 out of 179) cases. The relationship between recurrent laryngeal nerve and ITA was studied. ITA was anterior to RLN (in 70.89%) and posterior to RLN in 29.10%. Thus, ZT is an important landmark for identification of RLN during thyroidectomy (p value 0.001).

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Abbreviations

B/L:

Bilateral

ZT:

Zuckerkandl tubercle

RLN:

Recurrent laryngeal nerve

ITA:

Inferior thyroid artery

RLNP:

Recurrent laryngeal nerve palsy

RLNI:

Recurrent laryngeal nerve injury

References

  1. Mohebati A, Shaha AR (2012) Anatomy of thyroid and parathyroid glands and neurovascular relations. Clin Anat 25(1):19–31

    Article  CAS  PubMed  Google Scholar 

  2. Hayward NJ, Grodski S, Yeung M, Johnson WR, Sherpell J (2012) Recurrent laryngeal nerve injury in thyroid surgery: a review. ANZ J Surg 10(1111):15–21

    Google Scholar 

  3. Adwok JA (2007) Thyroid II-thyroidectomy. Surgery in Africa—monthly review. http://www.ptolemy.ca. Accessed Jan 2011

  4. Bakhsh KA, Galal HM, Lufti SA (2000) Thyroid surgery experience of King Saud Hospital, Unaizah, Al-Qassim. Saudi Med J 21(11):1088–1090

    CAS  PubMed  Google Scholar 

  5. Ready AR, Barnes AD (1994) Complications of thyroidectomy. Br J Surg 81(11):1555–1556

    Article  CAS  PubMed  Google Scholar 

  6. Mirilas P, Skandalakis JE (2003) Zuckerkandl’s tubercle: hannibal Ad Portas. J Am College Surg 196(5):796–801

    Article  Google Scholar 

  7. Shoja MM, Shane Tubbs R, Loukas M, Shokouhi G, Jerry Oakes W (2008) Emil Zuckerkandl (1849–1910) anatomist and pathologist. Annal Anatomy 190(1):33–36

    Article  Google Scholar 

  8. Costanzo M, Caruso LA, Veroux M, Messina DC, Marziani A, Cannizzaro MA (2005) The lobe of Zuckerkandl: an important sign of recurrent laryngeal nerve. Annal Ital Chir 76(4):337–341

    Google Scholar 

  9. Page C, Cuvelier P, Biet A, Boute P, Laude M, Strunski V (2009) Thyroid tubercle of Zuckerkandl: anatomical and surgical experience from 79 thyroidectomies. J Laryngol Otol 123(7):768–771

    Article  CAS  PubMed  Google Scholar 

  10. Pelizzo MR, Toniato A, Gemo G (1998) Zuckerkandl’s tuberculum: an arrow pointing to the recurrent laryngeal nerve (constant anatomical landmark). J Am College Surg 187(3):333–336

    Article  CAS  Google Scholar 

  11. Toniato A, Boschin IM (2008) The Zuckerkandl tubercle. Am J Surg 195(2):277

    Article  PubMed  Google Scholar 

  12. Gil-Carcedo E, Menéndez ME, Vallejo LA, Herrero D, Gil-Carcedo LM et al (2013) The Zuckerkandl tubercle: problematic or helpful in thyroid surgery? Eur Arch Otorhinolaryngol 270(8):2327–2332. doi:10.1007/s00405-012-2334-7

  13. Emin G, Gunay G (2012) Incidence and surgical importance of Zuckerkandl’s tubercle of the thyroid and its relations with recurrent laryngeal nerve. ISRN Surgery 2012, Article ID 450589, 5 pp

  14. Hisham AN, Lukman MR (2002) Recurrent laryngeal nerve in thyroid surgery: a critical appraisal. ANZ J Surg 72(12):887–889

    Article  PubMed  Google Scholar 

  15. Yun JS, Lee YS, Jung JJ et al (2008) The Zuckerkandl’s tubercle: a useful anatomical landmark for detecting both the recurrent laryngeal nerve and the superior parathyroid during thyroid surgery. Endocrine J 55(5):925–930

    Article  Google Scholar 

  16. Gravante G, Delogu D, Rizzello A et al (2007) The Zuckerkandl tubercle. Am J Surg 193:484–485

    Article  PubMed  Google Scholar 

  17. Sheahan P, Murphy MS (2011) Thyroid tubercle of Zuckerkandl: importance in thyroid surgery. Laryngoscope 121:2335–2337

    Article  PubMed  Google Scholar 

  18. Delbridge L (2003) Total thyroidectomy: the evolution of surgical technique. ANZ J Surg 73:761–768

    Article  PubMed  Google Scholar 

  19. Gauger PG, Delbridge LW, Thompson NW, Crummer P, Reeve TS (2001) Incidence and importance of the tubercle of Zuckerkandl in thyroid surgery. Euro J Surg 167(4):249–254

    Article  CAS  Google Scholar 

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Authors and Affiliations

  1. Department of ENT, SMS Medical College and Hospital, 3/1, Heera Bagh Flats, Sawai Ram Singh Road, Jaipur, Rajasthan, 302004, India

    Priyanka Singh, Kalpana Sharma & Sunita Agarwal

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  1. Priyanka Singh
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  2. Kalpana Sharma
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  3. Sunita Agarwal
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Correspondence to Sunita Agarwal.

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All authors declares that they have no conflict of interest.

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All procedures performed in the study were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Informed consent was obtained from all individual participants included in the study.

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Singh, P., Sharma, K. & Agarwal, S. Per Operative Study of Relation of Zuckerkandl Tubercle with Recurrent Laryngeal Nerve in Thyroid Surgery. Indian J Otolaryngol Head Neck Surg 69, 351–356 (2017). https://doi.org/10.1007/s12070-017-1148-8

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