{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,22]],"date-time":"2026-04-22T16:05:12Z","timestamp":1776873912412,"version":"3.51.2"},"reference-count":39,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2023,10,30]],"date-time":"2023-10-30T00:00:00Z","timestamp":1698624000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Surg."],"abstract":"<jats:sec><jats:title>Objective<\/jats:title><jats:p>To 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.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>A total of 421 patients (mean (min-max) age: 45.6 (18\u201378) 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.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Most 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\u20131\u2005cm from ZT] in 46.6% and Class 3 [&amp;lt;0.5\u2005cm 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\u20131\u2005cm from the ZT in 56.9% and 42.7% of grade 2 and grade 3 ZTs, respectively, and &amp;lt;0.5\u2005cm from the ZT in 46.1% of grade 3 ZTs.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>In 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.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fsurg.2023.1289941","type":"journal-article","created":{"date-parts":[[2023,10,30]],"date-time":"2023-10-30T09:18:26Z","timestamp":1698657506000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":3,"title":["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"],"prefix":"10.3389","volume":"10","author":[{"given":"Ercument","family":"Gurluler","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2023,10,30]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"207","DOI":"10.1007\/s12262-013-0856-x","article-title":"Salient anatomical landmarks of thyroid and their practical significance in thyroid surgery: a pictorial review of thyroid surgical anatomy (revisited)","volume":"76","author":"Bhargav","year":"2014","journal-title":"Indian J Surg"},{"key":"B2","doi-asserted-by":"publisher","first-page":"249","DOI":"10.1016\/j.jviscsurg.2013.04.003","article-title":"Complications after total thyroidectomy","volume":"150","author":"Christou","year":"2013","journal-title":"J Visc Surg"},{"key":"B3","doi-asserted-by":"publisher","first-page":"73","DOI":"10.1007\/s00276-022-03054-y","article-title":"Identification of valid anatomical landmarks to locate and protect recurrent laryngeal nerve during thyroid surgery: a cadaveric study","volume":"45","author":"Patra","year":"2023","journal-title":"Surg Radiol Anat"},{"key":"B4","doi-asserted-by":"publisher","first-page":"115","DOI":"10.1515\/iss-2021-0038","article-title":"Surgical tips and techniques to avoid complications of thyroid surgery","volume":"7","author":"Stefanou","year":"2022","journal-title":"Innov Surg Sci"},{"key":"B5","doi-asserted-by":"publisher","first-page":"659","DOI":"10.1007\/s00268-004-7197-7","article-title":"Identification of the nonrecurrent laryngeal nerve during thyroid surgery: 20-year experience","volume":"28","author":"Toniato","year":"2004","journal-title":"World J Surg"},{"key":"B6","first-page":"90","article-title":"Non-recurrent inferior laryngeal nerve: case report and review of the literature","volume":"4","author":"Iorgulescu","year":"2014","journal-title":"J Med Life"},{"key":"B7","first-page":"107","article-title":"A \u201cpilot light\u201d of the right non-recurrent laryngeal nerve, una spia del nervo non-ricorrente destro, surgical pathology, department of medical and surgical sciences, university of Padua, Italy","volume":"30","author":"Toniato","year":"2010","journal-title":"Acta Otorhinolaryngol Ital"},{"key":"B8","doi-asserted-by":"publisher","first-page":"84","DOI":"10.1016\/j.rpedm.2014.05.001","article-title":"The non-recurrent laryngeal nerve: an anatomical \u201ctrap\u201d","volume":"9","author":"Guerreiro","year":"2014","journal-title":"Rev Port Endocrinol Diabetes Metab"},{"key":"B9","doi-asserted-by":"publisher","first-page":"670","DOI":"10.3390\/diagnostics10090670","article-title":"Anatomical variations of the recurrent laryngeal nerve and implications for injury prevention during surgical procedures of the neck","volume":"10","author":"Thomas","year":"2020","journal-title":"Diagnostics (Basel)"},{"key":"B10","doi-asserted-by":"publisher","first-page":"265","DOI":"10.1016\/j.anorl.2015.08.002","article-title":"Recurrent laryngeal nerve landmarks during thyroidectomy","volume":"132","author":"Ngo Nyeki","year":"2015","journal-title":"Eur Ann Otorhinolaryngol Head Neck Dis"},{"key":"B11","doi-asserted-by":"publisher","first-page":"19","DOI":"10.1002\/ca.21220","article-title":"Anatomy of thyroid and parathyroid glands and neurovascular relations","volume":"25","author":"Mohebati","year":"2012","journal-title":"Clin Anat"},{"key":"B12","doi-asserted-by":"publisher","first-page":"79","DOI":"10.14744\/SEMB.2018.37928","article-title":"A review of methods for the preservation of laryngeal nerves during thyroidectomy","volume":"52","author":"Uluda\u011f","year":"2018","journal-title":"Sisli Etfal Hastan Tip Bul"},{"key":"B13","doi-asserted-by":"publisher","first-page":"47","DOI":"10.1016\/j.ijsu.2016.08.019","article-title":"Predictors and risk factors of hypoparathyroidism after total thyroidectomy","volume":"34","author":"Cho","year":"2016","journal-title":"Int J Surg"},{"key":"B14","doi-asserted-by":"publisher","first-page":"925","DOI":"10.1507\/endocrj.k08e-132","article-title":"The Zuckerkandl\u2019s tubercle: a useful anatomical landmark for detecting both the recurrent laryngeal nerve and the superior parathyroid during thyroid surgery","volume":"55","author":"Yun","year":"2008","journal-title":"Endocr J"},{"key":"B15","first-page":"61","article-title":"Nebst bemerkungen uber die epithelkorperchen des menschen","author":"Zuckerkandl","year":"1902","journal-title":"Anat Hefte"},{"key":"B16","doi-asserted-by":"publisher","first-page":"91","DOI":"10.4103\/cjhr.cjhr_107_17","article-title":"Review of surgical anatomy of tubercle of Zuckerkandl and its importance in thyroid surgery","volume":"5","author":"Viveka","year":"2018","journal-title":"Chrismed J Health Res"},{"key":"B17","doi-asserted-by":"publisher","first-page":"92","DOI":"10.1016\/j.amsu.2016.03.030","article-title":"Zuckerkandl tubercle in thyroid surgery: is it a reality or a myth?","volume":"7","author":"Irkorucu","year":"2016","journal-title":"Ann Med Surg (Lond)"},{"key":"B18","doi-asserted-by":"publisher","first-page":"333","DOI":"10.1016\/s1072-7515(98)00160-4","article-title":"Zuckerkandl\u2019s tuberculum: an arrow pointing to the recurrent laryngeal nerve (constant anatomical landmark)","volume":"187","author":"Pelizzo","year":"1998","journal-title":"J Am Coll Surg"},{"key":"B19","first-page":"296","article-title":"Surgical discovery of parathyroid glands and the recurrent laryngeal nerve. Application of well known embryological concepts in the operating room","volume":"49","author":"Chevallier","year":"1995","journal-title":"Ann Chir"},{"key":"B20","doi-asserted-by":"publisher","first-page":"249","DOI":"10.1080\/110241501300091363","article-title":"Incidence and importance of the tubercle of Zuckerkandl in thyroid surgery","volume":"167","author":"Gauger","year":"2001","journal-title":"Eur J Surg"},{"key":"B21","doi-asserted-by":"publisher","first-page":"450589","DOI":"10.5402\/2012\/450589","article-title":"Incidence and surgical importance of Zuckerkandl\u2019s tubercle of the thyroid and its relations with recurrent laryngeal nerve","volume":"2012","author":"Gurleyik","year":"2012","journal-title":"ISRN Surg"},{"key":"B22","doi-asserted-by":"publisher","first-page":"147","DOI":"10.1007\/s12070-020-01854-5","article-title":"Extended surgical implication of tubercle of Zuckerkandl in total thyroidectomy","volume":"73","author":"Prakash","year":"2021","journal-title":"Indian J Otolaryngol Head Neck Surg"},{"key":"B23","doi-asserted-by":"publisher","first-page":"312","DOI":"10.1007\/s13193-015-0482-0","article-title":"The tubercle of Zuckerkandl: an important landmark revisited","volume":"7","author":"Irawati","year":"2016","journal-title":"Indian J Surg Oncol"},{"key":"B24","doi-asserted-by":"publisher","first-page":"109","DOI":"10.1007\/s00595-006-3346-y","article-title":"Relationship between Zuckerkandl\u2019s tubercle and the inferior laryngeal nerve including the laryngeal branches","volume":"37","author":"Yalcin","year":"2007","journal-title":"Surg Today"},{"key":"B25","doi-asserted-by":"publisher","first-page":"351","DOI":"10.1007\/s12070-017-1148-8","article-title":"Per operative study of relation of Zuckerkandl tubercle with recurrent laryngeal nerve in thyroid surgery","volume":"69","author":"Singh","year":"2017","journal-title":"Indian J Otolaryngol Head Neck Surg"},{"key":"B26","doi-asserted-by":"publisher","first-page":"2327","DOI":"10.1007\/s00405-012-2334-7","article-title":"The Zuckerkandl tubercle: problematic or helpful in thyroid surgery?","volume":"270","author":"Gil-Carcedo","year":"2013","journal-title":"Eur Arch Otorhinolaryngol"},{"key":"B27","doi-asserted-by":"publisher","first-page":"768","DOI":"10.1017\/S0022215108004003","article-title":"Thyroid tubercle of Zuckerkandl: anatomical and surgical experience from 79 thyroidectomies","volume":"123","author":"Page","year":"2009","journal-title":"J Laryngol Otol"},{"key":"B28","doi-asserted-by":"publisher","first-page":"853","DOI":"10.1002\/ca.21192","article-title":"Topography of the recurrent laryngeal nerve in relation to the thyroid artery, Zuckerkandl tubercle, and berry ligament in Kenyans","volume":"24","author":"Kaisha","year":"2011","journal-title":"Clin Anat"},{"key":"B29","doi-asserted-by":"publisher","first-page":"484","DOI":"10.1016\/j.amjsurg.2006.06.040","article-title":"The Zuckerkandl tubercle","volume":"193","author":"Gravante","year":"2007","journal-title":"Am J Surg"},{"key":"B30","doi-asserted-by":"publisher","first-page":"2335","DOI":"10.1002\/lary.22188","article-title":"Thyroid tubercle of Zuckerkandl: importance in thyroid surgery","volume":"121","author":"Sheahan","year":"2011","journal-title":"Laryngoscope"},{"key":"B31","doi-asserted-by":"publisher","first-page":"23","DOI":"10.4038\/cmj.v60i1.7141","article-title":"Morphology of the tubercle of Zuckerkandl and its importance in thyroid surgery","volume":"60","author":"Rajapaksha","year":"2015","journal-title":"Ceylon Med J"},{"key":"B32","doi-asserted-by":"publisher","first-page":"38","DOI":"10.1159\/000355823","article-title":"Thyroid tubercle of Zuckerkandl is more consistenly present and larger on the right: a prospective series","volume":"3","author":"Mehanna","year":"2014","journal-title":"Eur Thyroid J"},{"key":"B33","doi-asserted-by":"publisher","first-page":"918","DOI":"10.1007\/s00595-007-3510-z","article-title":"Grades of Zuckerkandl\u2019s tubercle in normal thyroids","volume":"37","author":"Mirilas","year":"2007","journal-title":"Surg Today"},{"key":"B34","doi-asserted-by":"publisher","first-page":"e2249","DOI":"10.1590\/0100-6991e-20192249","article-title":"Can the Zuckerkandl tubercle assist in the location of the inferior laryngeal nerve during thyroidectomies?","volume":"46","author":"Freitas","year":"2019","journal-title":"Rev Col Bras Cir"},{"key":"B35","doi-asserted-by":"publisher","first-page":"490390","DOI":"10.1155\/2012\/490390","article-title":"A closer look at laryngeal nerves during thyroid surgery: a descriptive study of 584 nerves","volume":"2012","author":"Pradeep","year":"2012","journal-title":"Anat Res Int"},{"key":"B36","doi-asserted-by":"publisher","first-page":"91","DOI":"10.1007\/s00268-012-1782-y","article-title":"Increased detection of non-recurrent inferior laryngeal nerve (NRLN) during thyroid surgery using systematic intraoperative neuromonitoring (IONM)","volume":"37","author":"Donatini","year":"2013","journal-title":"World J Surg"},{"key":"B37","doi-asserted-by":"publisher","first-page":"130","DOI":"10.33545\/surgery.2020.v4.i3b.480","article-title":"A prospective study: Zuckerkandl tubercle an important anatomical landmark in identification of recurrent laryngeal nerve in thyroid surgery","volume":"4","author":"Bagadiya","year":"2020","journal-title":"Int J Surg Sci"},{"key":"B38","doi-asserted-by":"publisher","first-page":"98","DOI":"10.1016\/s1072-7515(99)00231-8","article-title":"Zuckerkandl\u2019s tuberculum","volume":"190","author":"Ko\u00e7ak","year":"2000","journal-title":"J Am Coll Surg"},{"key":"B39","doi-asserted-by":"publisher","first-page":"251","DOI":"10.1046\/j.1440-1622.2000.01800.x","article-title":"Zuckerkandl\u2019s tubercle of the thyroid gland in association with pressure symptoms: a coincidence or consequence?","volume":"70","author":"Hisham","year":"2000","journal-title":"Aust N Z J Surg"}],"container-title":["Frontiers in Surgery"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fsurg.2023.1289941\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,10,30]],"date-time":"2023-10-30T09:18:32Z","timestamp":1698657512000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fsurg.2023.1289941\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,10,30]]},"references-count":39,"alternative-id":["10.3389\/fsurg.2023.1289941"],"URL":"https:\/\/doi.org\/10.3389\/fsurg.2023.1289941","relation":{},"ISSN":["2296-875X"],"issn-type":[{"value":"2296-875X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,10,30]]},"article-number":"1289941"}}