Brandon Michael Henry1, Beatrice Sanna2, Jens Vikse3, Matthew J Graves4, Alexandru Spulber5, Cecylia Witkowski5, Iwona M Tomaszewska6, R Shane Tubbs7, Krzysztof A Tomaszewski4. 1. International Evidence-Based Anatomy Working Group, 12 Kopernika St, 31-034 Krakow, Poland; Department of Anatomy, Jagiellonian University Medical College, 12 Kopernika St, 31-034 Krakow, Poland. Electronic address: bmhenry55@gmail.com. 2. Faculty of Medicine and Surgery, University of Cagliari, S.S. 554, Bivio Sestu, 09042 Monserrato, CA, Sardinia, Italy. 3. International Evidence-Based Anatomy Working Group, 12 Kopernika St, 31-034 Krakow, Poland; Division of Medicine, Stavanger University Hospital, Gerd-Ragna Bloch Thorsens gate 8, 4011 Stavanger, Norway. 4. International Evidence-Based Anatomy Working Group, 12 Kopernika St, 31-034 Krakow, Poland; Department of Anatomy, Jagiellonian University Medical College, 12 Kopernika St, 31-034 Krakow, Poland. 5. Department of Anatomy, Jagiellonian University Medical College, 12 Kopernika St, 31-034 Krakow, Poland. 6. Department of Medical Education, Jagiellonian University Medical College, 16 św. Łazarza Street, 31-530 Krakow, Poland. 7. Seattle Science Foundation, 550 17th Ave, James Tower, Suite 600, Seattle, WA 28122, USA.
Abstract
OBJECTIVE: Zuckerkandl's tubercle (ZT), when present, is an anatomical landmark by which surrounding structures such as the recurrent laryngeal nerve (RLN) can be identified intraoperatively. This study aimed to investigate the prevalence and anatomical characteristics of Zuckerkandl's tubercle by combining cadaveric dissection with a meta-analysis. METHODS: Through October 2016, an extensive search of PubMed, CNKI, ScienceDirect, EMBASE, BIOSIS, SciELO, and Web of Science was completed. Extracted data, along with the findings from our cadaveric dissections, were pooled into a meta-analysis to assess the prevalence and size of ZT and its relationship to the RLN. RESULTS: The pooled prevalence estimate of a ZT was 70.2% in the general population, 65.0% of which were considered Grade 0 tubercles (<1.0cm) and 35.0% Grade 1 (≥1.0cm). The RLN ran posteromedially to the ZT in 82.7% of cases, laterally to it in 8.7%, and on top of it in 8.6% of hemilarynges. CONCLUSION: RLN palsy is a common postoperative complication and cause for litigation following neck surgery. The ZT is a common component of the thyroid gland and with proper knowledge, surgeons can use it to reliably and quickly identify the RLN during operative procedures.
OBJECTIVE: Zuckerkandl's tubercle (ZT), when present, is an anatomical landmark by which surrounding structures such as the recurrent laryngeal nerve (RLN) can be identified intraoperatively. This study aimed to investigate the prevalence and anatomical characteristics of Zuckerkandl's tubercle by combining cadaveric dissection with a meta-analysis. METHODS: Through October 2016, an extensive search of PubMed, CNKI, ScienceDirect, EMBASE, BIOSIS, SciELO, and Web of Science was completed. Extracted data, along with the findings from our cadaveric dissections, were pooled into a meta-analysis to assess the prevalence and size of ZT and its relationship to the RLN. RESULTS: The pooled prevalence estimate of a ZT was 70.2% in the general population, 65.0% of which were considered Grade 0 tubercles (<1.0cm) and 35.0% Grade 1 (≥1.0cm). The RLN ran posteromedially to the ZT in 82.7% of cases, laterally to it in 8.7%, and on top of it in 8.6% of hemilarynges. CONCLUSION: RLN palsy is a common postoperative complication and cause for litigation following neck surgery. The ZT is a common component of the thyroid gland and with proper knowledge, surgeons can use it to reliably and quickly identify the RLN during operative procedures.