While ZT is a great landmark, a large Zuckerkandl tubercle can be a headache. If it is hypertrophied (enlarged, usually due to goiter or Hashimoto’s thyroiditis), it can wrap around the RLN, pushing the nerve into a "safety hazard" position. In some cases, the nerve actually penetrates through the tubercle.
The Zuckerkandl tubercle is more than a mere anatomical variant; it is a constant and reliable landmark in thyroid surgery. Its identification is crucial for the safe dissection of the thyroid lobe, preventing injury to the recurrent laryngeal nerve, and preserving the parathyroid glands. For the endocrine surgeon, the axiom remains: "Find the Zuckerkandl tubercle, and you will find the nerve." zuckerkandl tubercle
The Zuckerkandl tubercle is arguably the most reliable landmark for locating the RLN. In the vast majority of cases, the RLN runs in a groove medial to the tubercle. While ZT is a great landmark, a large