Incidence and importance of the tubercle of Zuckerkandl in thyroid surgery

Objective: To define the incidence of a distinct tubercle of Zuckerkandl (T Z) and confirm its anatomical relationships with the recurrent laryngeal ne rve and the superior parathyroid gland. Design: Two prospective series. Setting: University teaching hospital, Australia. Subjects: 200 patients who required thyroidectomy. Interventions: Anatomical and clinical observations in two series of patien ts (n = 100 in each). The first defined the incidence of a TZ and preoperat ive symptoms; the second delineated the relationship of the TZ to the recur rent laryngeal nerve and the superior parathyroid gland. Main outcome measures: Anatomical relationships. Results: A TZ was identified in 63% of patients and was >1 cm in 45%. In 93 % of patients with an enlarged TZ, the recurrent laryngeal nerve lay medial to it and the nerve was found lateral to the TZ in 7% of cases. The superi or parathyroid gland was usually cranial to the TZ and posterior to the rec urrent laryngeal nerve. The size and position of the TZ did not correlate c learly with symptoms. Conclusions: The TZ is a distinct feature of the thyroid gland that can be recognised during most thyroidectomies. The size and the position of the TZ have no constant relationship to preoperative symptoms. An understanding o f the consistent anatomical relationship between the TZ and recurrent laryn geal nerve and superior parathyroid gland is crucial for safe thyroidectomy .