Identifying Recurrent Laryngeal Nerve in Thyroid Surgery Using Relationship with Superior Parathyroid Gland and Tubercle of Zuckerkandl
Article Sidebar
Main Article Content
Abstract
Introduction: Recurrent laryngeal nerves (RLN) are particularly prone to injury during thyroid surgeries due to its intimate relationship and proximity with the gland. Zuckerkandl’s tubercle (ZT) helps in preserving RLN intra operative.
Material and Methods: A prospective study for identifying RLN in thyroid surgery using relationship with superior parathyroid gland and tubercle of Zuckerkandl was conducted on 50 thyroidectomy patients between August 2013 and February 2014.
Results: In all cases ZT was identified. Temporary paralysis of RLN was seen in 3 (6%) cases and permanent paralysis in 2 (4%) of cases.
Discussion: The site of greatest risk during thyroidectomy to the RLN is in the last 2-3 cm extralaryngeal course of the nerve. Relationship of recurrent laryngeal nerve with superior parathyroid gland and tubercle of Zukerkandl (ZT) is known.
Conclusion: Use of ZT and superior parathyroids as a landmark allows safe dissection of RLN.
Article Details
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
References
Mirilas P, Skandalakis JA. Zuckerkandl's tubercle: hannibal ad portas. Journal of the American College of Surgeons 2003;196:796-801
Shoja MM, Tubbs RS, Loukas M, Shokouhi G, Oakes WJ. Emil Zuckerkandl (1849–1910): anatomist and pathologist. Annals of Anatomy 2008;190:33-36
Page C, Cuvelier P, Biet A, Boute P, Laude M, Strunski V. Thyroid tubercle of Zuckerkandl: anatomical and surgical experience from 79 thyroidectomies. Journal of Laryngology and Otology 2009;123(7):768–771
Pelizzo MR, Toniato A, Gemo G. Zuckerkandl's tuberculum: an arrow pointing to the recurrent laryngeal nerve (constant anatomical landmark). Journal of the American College of Surgeons 1998;187(3):333–336
Hisham AN, Lukman MR. Recurrent laryngeal nerve in thyroid surgery: a critical appraisal. ANZ Journal of Surgery 2002;72(12):887-889
Serpell JW. New operative surgical concept of two fascial layers enveloping the recurrent laryngeal nerve. Annals of Surgical Oncology 2010;17(6):1628–1636
Gauger PG, Delbridge LW, Thompson NW, Crummer P, Reeve TS. Incidence and importance of the tubercle of Zuckerkandl in thyroid surgery. European Journal of Surgery 2001;167(4):249-254
Yun JS, Lee YS, Jung JJ, Nam KH, Chung WY, Chang HS, et al. The Zuckerkandl's tubercle: a useful anatomical landmark for detecting both the recurrent laryngeal nerve and the superior parathyroid during thyroid surgery. Endocrine Journal 2008; 55(5):925-930.
Kaisha EW, Wobenjo A , Saidi H. Topography of the recurrent laryngeal nerve in relation to the thyroid artery, Zuckerkandl tubercle, and Berry ligament in Kenyans. Clinical Anatomy 2001;24:853–857
Yalçin B, Poyrazoǧlu Y, Ozan H. Relationship between Zuckerkandl's tubercle and the inferior laryngeal nerve including the laryngeal branches. Surgery Today 2007; 37(2):109–113
Yalçin B, Ozan H. Relationship between the Zuckerkandl's tubercle and entrance point of the inferior laryngeal nerve. Clinical Anatomy 2007;20(6):640–643
Gurleyik E. Three variations of the laryngeal nerve in the same patient: a case report. Journal of Medical Case Reports 2001;5:266
Toniato A, Boschin IM. The Zuckerkandl tubercle. American Journal of Surgery 2008;195(2):277