The incidence and grade of tubercle of zuckerkandl and its relationship to the course of recurrent laryngeal nerve in thyroid surgery

Abstract

Aim of the Study: The aim is to study the incidence and grade of Zuckerkandl’s tubercle (ZT) and the course of recurrent laryngeal nerve (RLN) with respect to the grade of ZT. Settings and Design: A prospective observational anatomical study. Materials and Methods: The relationship of ZT to RLN was studied, and the size of the ZT was measured and graded according to Pelizzo’s grading system in all cases of routine thyroidectomy in 36 patients (45 sides) from December 2018 to November 2019. Results: ZT was present in 32 (71.11%) of the sides, more commonly on the right side in 24 (88.89%) with a P value of 0.001. Among the total thyroidectomy, bilateral ZT was present in 7 cases (77.78%). In the 45 sides Grade 0 was noted in 13/45 (28.89%), Grade I 14/45 (31.11%), Grade II 9/45 (20%), and Grade III 9/45 (20%) with a P value of 0.001. ZT more than 0 but less than 1 cm was the most common occurrence (Grade I and II). In the 32 sides which had ZT, 23/32 (71.88%) were Type A (posterior) and 9/32 (28.12%) were type D (lateral) with a P value of 0.01. Conclusions: The identification and meticulous dissection of ZT ensures completeness of thyroidectomy. As the size of the ZT increases, the nerve often runs posterior and medial to surface of ZT. The site of ZT can be considered an eloquent area in thyroid surgery as it lies in proximity to the RLN and superior parathyroid gland.