Morphology of the tubercle of zuckerkandl and its importance in thyroid surgery a rajapaksha, r fernando, n ranasinghe, s iddagoda abstract the tubercle of zuckerkandl zt is an embryological remnant of the thyroid gland. Zuckerkandl tubercles are the projections of normal thyroid tissue from the posterior or posteromedial margin of the thyroid gland that extend posterior to the tracheoesophageal groove. Zuckerkandl tubercle zt is a lateral projection from the lateral thyroid lobe which is a constant landmark for finding the recurrent laryngeal nerve during thyroid surgery. Each of these remnants plays a critical role in thyroi. A 60yearold female patient with large multinodular goiter was treated with total thyroidectomy. Incidence and morphology of the zuckerkandls tubercle. Pdf relationship between the zuckerkandls tubercle and. Presence and size of the zt was prospectively assessed during thyroidectomies done at a single surgical unit during 20.
This tubercle has been documented in the surgical literature due to its relevance in locating the recurrent laryngeal nerve. Zuckerkandl s tubercle zt is the posterior extension of lateral lobes. 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. Zuckerkandl tubercle zt is the posterior projection of lateral lobes of the thyroid gland and is a common anatomical structure observed in 6090% of cases. We did not find a zuckerkandl s tubercle individualised as an ectopic thyroid 0. In most cases the nerve traverses just medial to the tubercle and is hidden from view until the tubercle is medially retracted. Furthermore, removal of the tz is critical for the adequate performance of a total thyroidectomy.
The tubercle of zuckerkandl zt is an embryological remnant of the thyroid gland. Zuckerkandl s tubercle zt is defined as the extension of the lateral lobes of the thyroid, composing of thyroid tissue only. Tubercle of zuckerkandl tz is the posterior or posterolateral extension of thyroid gland. Musajo, fg, mangiante, g, ischia, a, marchiori, l, benati, g, mainente, m, et al. It is made up of small spherical cells that contain. Grades of zuckerkandls tubercle in normal thyroids.
Emil zuckerkandl 18491910, an austrian anatomist who described a lateral projection of the thyroid gland, was an early pioneer of clinical anatomy. The superior parathyroid gland, also derived from the 4th branchial cleft, is commonly located close to and cephalad to the tubercle. A recent case of zt with a nodular configuration caused clinical concern but was shown on biopsy to be normal thyroid tissue. Many homeostatic processes that occur within the body are dependent on various supporting hormonal systems for efficient functioning. Department of anatomy embryology, university of crete medical school, crete. Zuckerkandl tubercle zt is a lateral projection from the lateral. Zuckerkandls tubercle journal of the american college of surgeons. Pdf morphology of the tubercle of zuckerkandl and its importance. They are present in most patients and occur more commonly on the right and in the longitudinal center 50% of the lobe 1,2. Endocrine pancreas the transcription factor pax6 functions in the specification and maintenance of the differentiated cell lineages in the endocrine pancreas. The shape of the zuckerkandl s tubercle was sessile 70. The autism dysmorphology measure adm was developed to provide an efficient and reliable method to identify children with general dysmorphology on physical examination.
This is also the region where on the right side, in approximately 1% of cases, a. Prospective study on 144 patients 48 males, 96 females undergoing thyroidectomy 35 hemithyroidectomies, 109 total thyroidectomies from september 1st 2010. Grades of zuckerkandls tubercle in normal thyroids springerlink. This tubercle arises from the lateral anlage the thyroid gland develops from two anlages, and while the median analge is larger, the lateral one is. Zuckerkandls tubercle teeth disambiguation page providing links to topics that could be referred to by the same search term this disambiguation page lists articles associated with the. Review of surgical anatomy of tubercle of zuckerkandl and its. The purpose of this study was to investigate incidence and morphology of the zuckerkandl s tubercle. Articletitle relationship between zuckerkandl s tubercle and the inferior laryngeal nerve including the laryngeal branches surg today 37 109. Total and hemithyroidectomy were surgical procedures in 60 and 40 patients, respectively. This has a relationship with the recurrent laryngeal nerve rln. Identification and preservation of the recurrent laryngeal nerve is a major concern during thyroidectomies. Zuckerkandl s tubercle rln rln the left recurrent laryngeal nerve rln laryngeal entry point of rln gurleyik e.
The phenotype of pax6 knockout mice suggests nonredundant functions of the transcription factor in the. Tubercle of zuckerkandl e4ent ear, nose, throat, head. Two cases of enlarged zuckerkandls tubercle of the. Meticulous technique, combined with an understanding of thyroid embryology and anatomy, is the foundation of the surgical management today. Thyroid gland to form a tubercle known as zuckerkandl tubercle. Emil zuckerkandl described it in 1902 as the processus posterior glandulae thyreoideae. To define the incidence of a distinct tubercle of zuckerkandl tz and confirm its anatomical relationships with the recurrent laryngeal nerve and the superior parathyroid gland. Vc 2011 the american laryngological, rhinological and otological society, inc.
Review of surgical anatomy of tubercle of zuckerkandl and. Emil zuckerkandl, born in hungary in 1849, studied at the university of vienna where he was trained as an anatomist and surgeon. Forty specimens 80 sides were examined for this project, including 24 males and 16 female. Zuckerkandls tubercle of the thyroid gland in association. The tubercle of zuckerkandl is characterized as being a thickening in the thyroid gland where the ultimobranchial body merges with the median thyroid anlage and can enlarged to become a nodular process 48. Tubercle definition of tubercle by medical dictionary. Ralph waldo emerson, journals, 1863 zuckerkandl s tubercle is a distinct, welldocumented anatomical feature of the thyroid gland, with a plausible embryological basis of genesis. The tubercle was first described by otto madelung in 1867 as posterior horn of the thyroid. The tubercle of zuckerkandl is a poorly known and variable anatomical feature of the thyroid gland which may not, in fact, be so rare. The tubercle of zuckerkandl tz, which is the remant of the lateral thyroid process, is an important ana tomic structure that serves as a reliable landmark for the recurrent laryngeal nerve in thyroid surgery. In 1901, he described these encapsulated light brown organs joined by an isthmus, on the anterior surface of the aorta, just between the origin of the inferior mesenteric artery and the bifurcation of the iliac arteries. It is the condensed thyroid parenchyma located in the cricothyroid junction.
Although the structure is named after zuckerkandl, it was discovered first by otto madelung in 1867 as the posterior horn of the thyroid. Its close relationship to the recurrent laryngeal nerve rln makes it an. Zuckerkandls tubercle is a pyramidal extension of the thyroid gland, present at the most posterior side of each lobe. Variations of recurrent laryngeal nerve rln and zuckerkandl s tubercle zt, which is posterior extension of lateral lobes, may affect safety of thyroidectomy. Its close relationship to the recurrent laryngeal nerve rln makes it an important surgical landmark.
Gemsenjaeger, atlas of thyroid surgery isbn 97831450319 2009 georg thieme verlag kg 176 index functional autonomy and 70, 8889 multinodular goiter 75. One such anomaly, the tubercle of zuckerkandl tzn, is a posterolateral extension of the thyroid gland that has also been called as the posterior horn of thyroid described for the first time by otto madelung in 1867 and later by emil zuckerkandl 18491910. When enlarged, it is a reliable landmark for the rln because the nerve almost always courses medial and deep to it 15. The tubercle of zuckerkandl extends off of the posterior and lateral aspect of the thyroid lobes. A thorough understanding of thyroid anatomy is central to the performance of safe thyroid surgery 1.
A useful anatomical landmark for detecting both the recurrent laryngeal nerve and the superior parathyroid during thyroid surgery jisup yun 1, yong sang lee 2, jeong joo jung 2, kee hyun nam 2, woong youn chung 2, hang seok chang 2, cheong soo park 2. After freeing the tubercle of zuckerkandl and berry ligament, the rln returned back to its usual position in tracheaesophageal groove. Out of 39 records, 25 studies, reported total number of sides where tz was studied with prevalence percentages n 4231 sides. The zuckerkandl tubercle is generally found in 63% to 80% of patients undergoing thyroidectomy and is located between the superior and inferior lobes pointing toward the tracheoesophageal groove fig. What is the embryology and anatomy of the thyroid gland.
The tubercle of zuckerkandl is a posterior projection from lateral thyroid lobe in the vicinity of the extralaryngeal termination of recurrent laryngeal nerve. Pdf the tubercle of zuckerkandl zt is an embryological remnant of the thyroid gland. It is of variable size, from a hugely expanded mass down to just a small tongue of tissue, wrapped around the recurrent nerve and often extending behind the trachea and oesophagus. Relationship between the zuckerkandl s tubercle and entrance point of the inferior laryngeal nerve. It arises for embryological reasons, and it can be a reliable anatomical landmark for identifying the recurrent laryngeal nerve during thyroid surgery. Zt is a normal protuberance of the thyroid gland arising from the posterolateral margin fig 1. This tubercle is the most posterior pyramidal extension of pure thyroid tissues of the lateral lobes of the thyroid gland in the area of the ligament of berry. The mean tubercle dimensions were 11 mm transverse axis and 9 mm longitudinal axis. This paper presents two cases of this uncommon situation. The zuckerkandl s tubercle zt of the thyroid gland is a well. Ultraligation of the upper pt and individual ligation and division of the lateral, inferior, medial tubercle suspensory ligament recurrent laryngeal nerve e c branches of the inferior artery are. Incidence and importance of the tubercle of zuckerkandl in.
Its close relationship to the recurrent laryngeal nerve rln. Tubercle of zuckerkandl overlying the recurrent laryngeal nerve the posteriorlyplaced tubercle of zuckerkandl plays an important role in thyroid surgery. It has two dna binding domains, the paired domain and the homeodomain, in addition to a cterminal transactivation domain. 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. Pdf embryological descent, remnants and implications for.
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