Advertisement

The Recurrent Laryngeal Nerve and the Tubercle of Zuckerkandl

  • Steven R. Bomeli
  • Beata WojtczakEmail author
  • Hisham Abdullah
  • Romain E. Kania
  • David J. Terris
Chapter
  • 800 Downloads

Abstract

The tubercle of Zuckerkandl is the posterior and lateral projection of the thyroid gland. It was originally described by anatomists, and later became of interest to thyroid and parathyroid surgeons because of its close proximity to the recurrent laryngeal nerve and the superior parathyroid gland. It is more frequently found on the right side of the body, and when found bilaterally it is often larger on the right. It has been postulated that an enlarged tubercle of Zuckerkandl can cause symptoms of compression even in the absence of a large goiter, but it is clinically significant because of its use as a landmark for finding the recurrent laryngeal nerve and the superior parathyroid gland during surgery.

Keywords

Zuckerkandl Tubercle Recurrent laryngeal nerve Superior parathyroid gland 

Supplementary material

Video 9.1

Shows a surgeon’s view of the tubercle of Zuckerkandl being elevated to expose the recurrent laryngeal nerve and superior parathyroid gland (MP4 46088 kb)

References

  1. 1.
    Madelung OW. Anat. U. Chirurg. ud gland: Access. Post Arch. f. Klin. Chir. Bd; 1867.Google Scholar
  2. 2.
    Zuckerkandl E. Nebst Bemerkungen uber die Epithelkorperchen des Menschen. Anat Hefte. 1902;LXI:61.Google Scholar
  3. 3.
    Shoja MM, Tubbs RS, Loukas M, Shokouhi G, Jerry OW. Emil Zuckerkandl (1849–1910): anatomist and pathologist. Ann Anat. 2008;190(1):33–6.CrossRefPubMedGoogle Scholar
  4. 4.
    Chevallier JM, Martelli H, Wind P. Surgical discovery of parathyroid glands and the recurrent laryngeal nerve. Application of well known embryological concepts in the operating room. Ann Chir. 1995;49(4):296–304.PubMedGoogle Scholar
  5. 5.
    Mirilas P, Skandalakis JE. Zuckerkandl’s tubercle: Hannibal ad Portas. J Am Coll Surg. 2003;196(5):796–801.CrossRefPubMedGoogle Scholar
  6. 6.
    Mehanna R, Murphy MS, Sheahan P. Thyroid tubercle of Zuckerkandl is more consistently present and larger on the right: a prospective series. Eur Thyroid J. 2014;3(1):38–42.PubMedGoogle Scholar
  7. 7.
    Mansberger Jr AR, Wei JP. Surgical embryology and anatomy of the thyroid and parathyroid glands. Surg Clin North Am. 1993;73(4):727–46.PubMedGoogle Scholar
  8. 8.
    Skandalakis JE, Gray S, Todd NW. The pharynx and its derivatives. In: Skandalakis JE, Gray SW, editors. Embryology for surgeons. 2nd ed. Baltimore: Williams & Wilkins; 1994. p. 27–31.Google Scholar
  9. 9.
    Jr G. The gross anatomy of the parathyroid glands. J Pathol. 1938;46:133–49.CrossRefGoogle Scholar
  10. 10.
    Reeve TS, Delbridge L, Cohen A, Crummer P. Total thyroidectomy. The preferred option for multinodular goiter. Ann Surg. 1987;206(6):782–6.CrossRefPubMedPubMedCentralGoogle Scholar
  11. 11.
    Musajo FG, Mangiante G, Ischia A, et al. Zuckerkandl tubercle of the thyroid gland (anatomo-surgical study: preliminary considerations). Chir Ital. 1989;41(2–3):129–36.PubMedGoogle Scholar
  12. 12.
    Gauger PG, Delbridge LW, Thompson NW, Crummer P, Reeve TS. Incidence and importance of the tubercle of Zuckerkandl in thyroid surgery. Eur J Surg. 2001;167(4):249–54.CrossRefPubMedGoogle Scholar
  13. 13.
    Pelizzo MR, Toniato A, Gemo G. Zuckerkandl’s tuberculum: an arrow pointing to the recurrent laryngeal nerve (constant anatomical landmark). J Am Coll Surg. 1998;187(3):333–6.CrossRefPubMedGoogle Scholar
  14. 14.
    Kocak S, Aydintug S. Zuckerkandl’s tuberculum. J Am Coll Surg. 2000;190(1):98–9.CrossRefPubMedGoogle Scholar
  15. 15.
    Yalcin B, Poyrazoglu Y, Ozan H. Relationship between Zuckerkandl’s tubercle and the inferior laryngeal nerve including the laryngeal branches. Surg Today. 2007;37(2):109–13.CrossRefPubMedGoogle Scholar
  16. 16.
    Sheahan P, Murphy MS. Thyroid tubercle of Zuckerkandl: importance in thyroid surgery. Laryngoscope. 2011;121(11):2335–7.CrossRefPubMedGoogle Scholar
  17. 17.
    Kaisha W, Wobenjo A, Saidi H. Topography of the recurrent laryngeal nerve in relation to the thyroid artery, Zuckerkandl tubercle, and Berry ligament in Kenyans. Clin Anat. 2011;24(7):853–7.CrossRefPubMedGoogle Scholar
  18. 18.
    Page C, Cuvelier P, Biet A, Boute P, Laude M, Strunski V. Thyroid tubercle of Zuckerkandl: anatomical and surgical experience from 79 thyroidectomies. J Laryngol Otol. 2009;123(7):768–71.CrossRefPubMedGoogle Scholar
  19. 19.
    Gil-Carcedo E, Menendez ME, Vallejo LA, Herrero D, Gil-Carcedo LM. The Zuckerkandl tubercle: problematic or helpful in thyroid surgery? Eur Arch Otorhinolaryngol. 2013;270(8):2327–32.CrossRefPubMedGoogle Scholar
  20. 20.
    Hisham AN, Sarojah A, Mastura T, Lim TO. Prevertebral soft tissue measurements in thyroid enlargement: the value of lateral neck radiographs. Asian J Surg. 2004;27(3):172–5.CrossRefPubMedGoogle Scholar
  21. 21.
    Lee TC, Selvarajan SK, Curtin H, Mukundan S. Zuckerkandl tubercle of the thyroid: a common imaging finding that may mimic pathology. AJNR Am J Neuroradiol. 2012;33(6):1134–8.CrossRefPubMedGoogle Scholar
  22. 22.
    Hisham AN, Aina EN. Zuckerkandl’s tubercle of the thyroid gland in association with pressure symptoms: a coincidence or consequence? Aust N Z J Surg. 2000;70(4):251–3.CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing Switzerland 2016

Authors and Affiliations

  • Steven R. Bomeli
    • 1
  • Beata Wojtczak
    • 2
    Email author
  • Hisham Abdullah
    • 3
  • Romain E. Kania
    • 4
  • David J. Terris
    • 5
  1. 1.Department of Otolaryngology—Head and Neck SurgeryGeorgia Regents UniversityAugustaUSA
  2. 2.First Department and Clinic of General, Gastroenterological and Endocrine SurgeryWroclaw Medical UniversityWroclawPoland
  3. 3.Ministry of HealthPutrajayaMalaysia
  4. 4.Department of Otorhinolaryngology, Head & Neck SurgeryLariboisière University Hospital, Paris Diderot University, University Paris Sorbonne CitéParisFrance
  5. 5.Department of OtolaryngologyGeorgia Health Sciences University, GRU Thyroid CenterAugustaUSA

Personalised recommendations