Importance of tubercle of Zuckerkandl in thyroid surgery

👉The Tubercle of Zuckerkandl (TZ) is not only an important landmark, but also if not properly identified and carefully dissected, increases the chances of recurrent laryngeal nerve (RLN) injury. The new concept of a fascial plane separating the TZ and RLN reinforces the importance of identification TZ for safe dissection of the parathyroid glands and the RLN.

👉There is a fascial sleeve extending from the posterior ‘V’ lip of the superior pole of thyroid which passes posteriorly. This on anteromedial rotation becomes the superficial vascular fascial layer. This encloses the TZ.

👉Tubercle of Zuckerkandl is both the pointer to the RLN and also separates the superior and inferior parathyroid gland.

👉In this situation, it is necessary to mobilize TZ and also rotate it almost 180 degrees anteriorly and medially to expose the RLN and also for the safe dissection of parathyroid glands.

👉It works as a maker and a tool for safe thyroid surgery. In the changing paradigm of thyroid surgery, the TZ, which was an inconstant landmark has now become a constant landmark for identification of RLN.

👉The thyroid surgeon should be aware that it is more consistently found, usually larger on the right with anatomical variations and also might result in pressure symptoms especially in small goiters and becomes a friend as the surgeon experience increases.

👉Saba Retnam et al. World Journal of Endocrine Surgery May 2015

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