Salient Anatomical Landmarks of Thyroid and Their Practical Significance in Thyroid Surgery: a Pictorial Review of Thyroid Surgical Anatomy (Revisited)

Bhargav, Panchangam Ramakanth

doi:10.1007/s12262-013-0856-x

Cited by 7 publications

(8 citation statements)

References 35 publications

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“…2 ). Therefore, a thyroid surgeon should be aware of the all anatomic variations of the gland and of adjacent structures and must have a thorough knowledge of the normal anatomy to achive a high standard of care [19] , [20] , [21] , [22] . Additionally, it has therefore been recommended that an understanding of the embryology is important, and the combined embryological and anatomical approach to thyroid surgery is more useful than a purely anatomical one [2] , [12] .…”

Section: Discussionmentioning

confidence: 99%

Zuckerkandl tubercle in thyroid surgery: Is it a reality or a myth?

İrkörücü

2016

Annals of Medicine &Amp; Surgery

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BackgroundZuckerkandl 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. It is the condensed thyroid parenchyma located in the cricothyroid junction. Even today, ZT and its relationship with recurrent laryngeal nerve (RLN) is not well known by all surgeons. The objectives of the present study were to find out the incidence of ZT in our thyroidectomies and to investigate whether the ZT has a relationship with RLN. We also discussed how to prevent RLN injury during thyroidectomy.Materials and methodsOne hundred operations were performed by the same surgeon included in this study. All operations performed with intraoperative neuromonitorization (IONM) for proving the visualization of RLN. In each patient, particularly the ZT and its relationship with RLN searched and recorded. We also analyzed the patients in terms of sex, age, clinical diagnosis, and types of performed operations.ResultsIn 100 operations, 173 thyroid lobectomies were considered. 87 of these lobectomies were in right side and 86 in left side. The ZT was determined in 127 of 173 (73.41%) lobectomies. ZT was detected in 68 (78.16%) of right thyroid lobes whereas in 59 (68.60%) of left thyroid lobes. We observed that the ZT was detected more frequently in the right side. In 115 (90.55%) of these occasions, the recurrent nerve was directed upwards covered by the ZT.ConclusionsIf it is present, ZT is a real constant landmark pointing to the RLN. In order to find and protect RLN during thyroid surgery, a careful, bloodless, and meticulous dissection should be carried out around the ZT. Although our results are encouraging, further researches are still needed on this topic.

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Section: Discussionmentioning

confidence: 99%

Zuckerkandl tubercle in thyroid surgery: Is it a reality or a myth?

İrkörücü

2016

Annals of Medicine &Amp; Surgery

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“…The ectodermal component of thyroid parenchyma originate from the neuroectodermal ultimobranchial body giving rise to parafollicular or C (clear) cells of the thyroid gland, whereas endodermal follicular cells are developed from thyroid anlage. 3,4,9,10 The thyroid anlage is a small thickening of the endodermal epithelium in the foregut consisting of endodermal cells. This unique region is situated in the midline on the posterior part of the embryonic mouth cavity.…”

Section: Embryological Perspectivementioning

confidence: 99%

“…Another landmark in the anatomy of the thyroid gland is a thickening of thyroid parenchyma present near the posteriolateral aspect of the thyroid gland called as Tubercle of Zuckerkand. 3,9,10,[12][13][14] The highly vascularized thyroid gland is supplied by superior and inferior thyroid artery branches of external carotid artery and thyrocervical trunk, a branch of subclavian artery respectively. In some individuals an additional thyroidea ima artery, a branch of brachiocephalic trunk or aortic arch may also supply thyroid gland.…”

Section: Anatomical Perspectivementioning

confidence: 99%

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A cadaveric case report of dual thyroid: ectopic and normal location thyroid with brief review of literature

Sawant¹

2018

EMIJ

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Ectopic thyroid tissue is a rare congenital anomaly due to developmental defect in thyroid gland. Ectopic, accessory, or aberrant thyroid refers to the presence of thyroid tissue in locations other than normal pretracheal position in the anterior neck region. The thyroid dysgenesis occurs due to abnormal organogenesis of the thyroid gland leading to morphological variations, such as hypoplasia, hemiagenesis, and agenesis with ectopic thyroid being the most common form of thyroid dysgenesis. Here, we are presenting a case of dual thyroid in the form of ectopic or accessory thyroid tissue along with normal location thyroid found during a routine dissection of a female cadaveric body. The ectopic thyroid tissue was seen as an oval structure about 2.2 cm x 1.6cm x 1.0 cm, situated in the midline near the hyoid bone. It was located 10.2 cm superior to a normally located thyroid gland and consistent with the track of the thyroglossal duct. The ectopic thyroid tissue could be asymptomatic or it could present with any disorder affecting the main thyroid gland including malignancy. The significance of this cadaveric case report and a brief review of the literature on normal location thyroid gland and ectopic thyroid highlight an uncommon but potentially important congenital anomaly that can be a source of diagnostic confusion and a challenge for therapeutic management.

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“…The use of Zuckerkandl's tubercle as an anatomical landmark in identifying recurrent laryngeal nerve and superior parathyroid gland during total thyroidectomy: a prospective single-surgeon study 1. Introduction Thyroid surgery mandates the surgeons' expertise and in-depth knowledge of the surgical anatomy and embryogenesis, due to considerable risk of complications such as injury to the recurrent laryngeal nerve (RLN), superior laryngeal nerve, or the parathyroid glands which may result in profound lifelong consequences for the patients (1)(2)(3)(4).…”

mentioning

confidence: 99%

The use of Zuckerkandl's tubercle as an anatomical landmark in identifying recurrent laryngeal nerve and superior parathyroid gland during total thyroidectomy: a prospective single-surgeon study

Gurluler

2023

Front. Surg.

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ObjectiveTo determine the incidence and characteristics of Zuckerkandl's tubercle (ZT), and its relationship with recurrent laryngeal nerve (RLN) and the superior parathyroid gland (SPG) in the setting of total thyroidectomy.MethodsA total of 421 patients (mean (min-max) age: 45.6 (18–78) years, 76.2% were females) who had total thyroidectomy were included in this prospective single-surgeon thyroidectomy series study. Patient demographics and thyroidectomy indications (benign and malignant) were recorded in each patient. The presence, grade and laterality of ZT, and its relationship with RLN and SPG were recorded during surgery.ResultsMost of the thyroidectomy indications (69.1%) were related to a malignant disease. The ZT was unrecognizable in 41(9.7%) of 421 patients. In 380 patients with identifiable ZT, the grade 2 (46.3%) ZT was the most common finding. Majority of ZTs (92.9%) were unilaterally located (right-sided: 64.9%; left-sided: 35.1%). In majority of the cases (83.2%), the RLN was found to lie medial to ZT. Overall, SPG was identified in close proximity to ZT in 66.6% of patients (Class 2 [0.5–1 cm from ZT] in 46.6% and Class 3 [<0.5 cm from ZT] in 20.0%). SPG was more likely to be identified in close proximity to ZT when the grade of ZT was higher, which was found to be located 0.5–1 cm from the ZT in 56.9% and 42.7% of grade 2 and grade 3 ZTs, respectively, and <0.5 cm from the ZT in 46.1% of grade 3 ZTs.ConclusionIn conclusion, this prospective single-surgeon thyroidectomy series study indicates the likelihood of localizing the RLN medial to ZT, and the SPG in close proximity to ZT during total thyroidectomy operations. Hence, the ZT can be used as a reliable and constant landmark to localize both the RLN and the SPG during thyroid surgery, which enables minimizing the risk of iatrogenic injury to RLN, while ensuring a parathyroid-sparing thyroidectomy. The thyroid surgeon should have complete knowledge of thyroid gland anatomy and embryogenesis and should follow a careful and meticulous approach particularly for dissections around larger ZTs, given the increased likelihood of SPG and RLN to be in close proximity.

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Salient Anatomical Landmarks of Thyroid and Their Practical Significance in Thyroid Surgery: a Pictorial Review of Thyroid Surgical Anatomy (Revisited)

Cited by 7 publications

References 35 publications

Zuckerkandl tubercle in thyroid surgery: Is it a reality or a myth?

Zuckerkandl tubercle in thyroid surgery: Is it a reality or a myth?

A cadaveric case report of dual thyroid: ectopic and normal location thyroid with brief review of literature

The use of Zuckerkandl's tubercle as an anatomical landmark in identifying recurrent laryngeal nerve and superior parathyroid gland during total thyroidectomy: a prospective single-surgeon study

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