Title: Tubercle of Zuckerkandl as a Landmark for Identification of Recurrent Laryngeal Nerve Enabling Safe Thyroid Surgery- A Prospective Comparitive Study
Authors: Mahidhar Reddy Venkatapuram, Singamsetty Kalyan Kumar, Sridhar Thathekalva, Suneel Kumar Reddy Venkatapuram
DOI: http://dx.doi.org/10.18535/jmscr/v3i8.67
DIDS : 08.2015-XXXXXXX
Introduction:During thyroid surgery identification of Recurrent laryngeal nerve (RLN) is an essential step,as any injury to it will lead to hoarseness or loss of voice. Tubercle of zuckerkandl (TZ), a projection from the postero-lateral aspect of throid lobe, is a useful landmark in the identification of RLN which usually runs in its vicinity. Aim & Objective: The aim of this study is to demonstrate the effectiveness of RLN identification using the ZT as an anatomical landmark in comparison with the usual infer superior dissection of the tracheoesophageal groove. Study Design:A prospective comparitive study was carried on two groups of patients who underwent total thyroidectomy for multinodular goitre at general surgery department, narayana medical college, nellore.In one group RLN was identified by taking TZ as landmark and in other group RLN was identified with inferosuperior dissection of tracheooesophageal groove during thyroidectomy. Post operatively RLN integrity was recorded by vocal cord examination and both groups compared. Results:A total of 70 patients underwent total thyroidectomy, 21 females and 49 males. 38 underwent RLN identification using TZ as landmark (group A) and 32 underwent RLN identification by trcheooesophageal groove dissection (group B). The mean age of patients in both groups was equal. the incidence of RLN injury in group B was higher than in group A with statistically significant numbers. Conclusion: The findings of our study confirm that using TZ as landmark for identification of RLN is associated with low risk of injury to the latter thus enabling safe thyroid surgery. Keywords: Total Thyroidectomy, Tubercle of Zuckerkandl, Recurrent laryngeal nerve. 1. Zuckerkandl E. Nebst Bemerkungen über die Epithelkörperchen des Menschen. Anat Hefte. 1902;LXI:61. 2. Agarwal G, Aggarwal V. Is total thyroidectomy the surgical procedure of choice for benign multinodular goiter? An evidence-based review. World J Surg. 2008;32:1313–1324.[PubMed] 3. Pelizzo MR, Toniato A, Gemo G. Zuckerkandl's tuberculum: an arrow pointing to the recurrent laryngeal nerve (constant anatomical landmark) J Am Coll Surg. 1998;187:333–336.[PubMed] 4. Hisham AN, Aina EN. Zuckerkandl's tubercle of the thyroid gland in association with pressure symptoms: a coincidence or consequence? Aust NZ J Surg. 2000;70:251–253.[PubMed] 5. Sheahan P, Murphy MS. Thyroid tubercle of Zuckerkandl: importance in thyroid surgery.Laryngoscope. 2011;121:2335–2337. [PubMed] 6. Gauger PG, Delbridge LW, Thompson NW, Crummer P, Reeve TS. Incidence and importance of the tubercle of Zuckerkandl in thyroid surgery. Eur J Surg. 2001;167:249–254.[PubMed] 7. Gurleyik E. Two cases of enlarged Zuckerkandl's tubercle of the thyroid displacing the recurrent laryngeal nerve laterally. Case Report Med. 2011;2011-:303861. [PMC free article][PubMed] 8. Rafferty MA, Goldstein DP, Rotstein L, et al. Completion thyroidectomy versus total thyroidectomy: is there a difference in complication rates? An analysis of 350 patients. J Am Coll Surg. 2007;205:602–607. [PubMed] 9. Gil-Carcedo Sanudo E, Menendez Arguelles ME, Vallejo Valdezate LA, Herrero Calvo D, Gil-Carcedo Garcia LM. Zuckerkandl's tubercle. Location, shape and dimensions (in Spanish)Acta Otorinolaringol Esp. 2012;63:443–449. 10. Sancho JJ, Pascual-Damieta M, Pereira JA, Carrera MJ, Fontane J, Sitges-Serra A. Risk factors for transient vocal cord palsy after thyroidectomy. Br J Surg. 2008;95:961–967.[PubMed] 11. Sheahan P, O'Connor A, Murphy MS. Risk factors for recurrent laryngeal nerve neuropraxia postthyroidectomy. Otolaryngol Head Neck Surg. 2012;146:900–905.[PubMed 12. Abboud B, Sleilaty G, Braidy C, et al. Careful examination of thyroid specimen intraoperatively to reduce incidence of inadvertent parathyroidectomy during thyroid surgery.Arch Otolaryngol Head Neck Surg. 2007;133:1105–1110. [PubMed]Abstract
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