The Tubercle of Zuckerkandl : An Important Landmark Revisited

To study the incidence of the tubercle of Zuckerkandl (ZT) among Indian patients subjected to thyroid surgery at a tertiary care cancer centre and its relevance in localization of recurrent laryngeal nerve (RLN). Prospective study on 144 patients (48 males, 96 females) undergoing thyroidectomy (35 hemithyroidectomies, 109 total thyroidectomies) from September 1st 2010 - February 28th 2013. 144 specimen/253 lobes (129 right, 124 left) were evaluated. Findings were recorded by the same team to ensure consistency. Presence, shape, grade (Pelizzo’s) of ZT and relationship to RLN were documented. ZT was identified in 90.5 % (n = 229), commoner on the right (n = 120) than on left (n = 109). ZT was Grade 0 in 9.5 %, Grade I in 28.9 %, Grade II in 50.5 % and Grade III in 11 % of cases. In all patients ZT was unilobed. Recurrent laryngeal nerve (RLN) was consistent in position and was posterior to ZT in all cases. There were no branches of the RLN above the ZT. The ZT is a useful guide in locating RLN. Surgeon should be aware about the incidence, shape, grade and relation to RLN which is different in the Indian population as compared to what has been reported globally.