Thyroid Tubercle of Zuckerkandl: importance in thyroid surgery.

OBJECTIVE The Tubercle of Zuckerkandl (TZ), which is the remant of the lateral thyroid process, is an important anatomic structure that serves as a reliable landmark for the recurrent laryngeal nerve in thyroid surgery. Furthermore, removal of the TZ is critical for the adequate performance of a total thyroidectomy. However, there is little mention of the TZ in surgical textbooks or papers. METHODS Prospective observational study of 138 consecutive thyroid surgeries. The presence of the TZ, its size, and relationship to the recurrent laryngeal nerve, were recorded. RESULTS A total of 211 thyroid lobes were included in the study. The TZ was identified in 61.1% of all thyroid lobes. The median size was 8 mm (range = 3-40 mm). A TZ was more commonly identified on the right (69.6%) than on the left side (53.2%) (P = .02). The recurrent laryngeal nerve was found deep to the TZ in 98.4% of cases. CONCLUSIONS A TZ is present in the majority of thyroid lobes. Awareness of the TZ is critical in performing an adequate total thyroidectomy, and is very useful as a landmark for the recurrent laryngeal nerve.