Zuckerkandl's tubercle

Zuckerkandl's tubercle is an anatomical feature of the thyroid gland, first described by the Austrian anatomist Emil Zuckerkandl in the late 19th century. It is a posterior projection of the thyroid gland, often found at the junction of the upper two-thirds and lower one-third of the lateral lobes of the thyroid.

Anatomy

Zuckerkandl's tubercle is located on the posterior aspect of the thyroid gland, near the point where the gland is attached to the trachea. It is typically more prominent on the right side of the gland. The tubercle is an important landmark in thyroid surgery because of its proximity to the recurrent laryngeal nerve and the inferior thyroid artery.

Embryology

The development of Zuckerkandl's tubercle is related to the embryological descent of the thyroid gland. During embryogenesis, the thyroid gland originates from the foramen cecum at the base of the tongue and descends to its final position in the neck. Zuckerkandl's tubercle is thought to represent a remnant of the ultimobranchial body, which contributes to the formation of the parafollicular or C cells of the thyroid.

Clinical Significance

Zuckerkandl's tubercle is a critical landmark in thyroid surgery. Its identification can help surgeons avoid injury to the recurrent laryngeal nerve, which is essential for preserving vocal cord function. Damage to this nerve can result in vocal cord paralysis, leading to hoarseness or loss of voice.

The tubercle can also be involved in various thyroid pathologies, including goiter, thyroid nodules, and thyroid cancer. In cases of thyroidectomy, careful dissection around Zuckerkandl's tubercle is necessary to ensure complete removal of thyroid tissue while preserving surrounding structures.

Surgical Considerations

During thyroid surgery, the identification of Zuckerkandl's tubercle can assist in locating the recurrent laryngeal nerve. Surgeons often use the tubercle as a guide to trace the nerve's course. The tubercle's proximity to the inferior thyroid artery also makes it a useful landmark for identifying and preserving this vessel during dissection.

Pathology

In some cases, Zuckerkandl's tubercle may be enlarged or involved in pathological processes. Enlargement of the tubercle can occur in conditions such as Graves' disease or Hashimoto's thyroiditis. In such cases, the tubercle may be palpable on physical examination and can be visualized using ultrasound or CT scan.

Imaging

Zuckerkandl's tubercle can be visualized using various imaging modalities. Ultrasound is commonly used to assess the thyroid gland and can help identify the tubercle, especially in cases of thyroid enlargement or nodules. CT scan and MRI can also provide detailed images of the thyroid and surrounding structures, aiding in preoperative planning.

History

The tubercle is named after Emil Zuckerkandl, who first described it in 1902. Zuckerkandl was a prominent anatomist and pathologist, known for his contributions to the understanding of the anatomy of the endocrine system.

See also

• Thyroid gland
• Recurrent laryngeal nerve
• Thyroidectomy

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