title: Zuckerkandl's tubercle and its relationship to the recurrent laryngeal nerve: A cadaveric dissection and meta-analysis.
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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: 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.
authors.forename: Brandon Michael
authors.initials: BM
authors.lastname: Henry
authors.affiliation: Faculty of Medicine and Surgery, University of Cagliari, S.S. 554, Bivio Sestu, 09042 Monserrato, CA, Sardinia, Italy.
authors.forename: Beatrice
authors.initials: B
authors.lastname: Sanna
authors.affiliation: 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.
authors.forename: Jens
authors.initials: J
authors.lastname: Vikse
authors.affiliation: 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.
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: Graves
authors.affiliation: Department of Anatomy, Jagiellonian University Medical College, 12 Kopernika St, 31-034 Krakow, Poland.
authors.forename: Alexandru
authors.initials: A
authors.lastname: Spulber
authors.affiliation: Department of Anatomy, Jagiellonian University Medical College, 12 Kopernika St, 31-034 Krakow, Poland.
authors.forename: Cecylia
authors.initials: C
authors.lastname: Witkowski
authors.affiliation: Department of Medical Education, Jagiellonian University Medical College, 16 św. Łazarza Street, 31-530 Krakow, Poland.
authors.forename: Iwona M
authors.initials: IM
authors.lastname: Tomaszewska
authors.affiliation: Seattle Science Foundation, 550 17th Ave, James Tower, Suite 600, Seattle, WA 28122, USA.
authors.forename: R Shane
authors.initials: RS
authors.lastname: Tubbs
authors.affiliation: 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.
authors.forename: Krzysztof A
authors.initials: KA
authors.lastname: Tomaszewski
mesh_terms: D059925:Anatomic Landmarks; D002102:Cadaver; D004210:Dissection; D006801:Humans; D011183:Postoperative Complications; D012009:Recurrent Laryngeal Nerve / Q000033:anatomy & histology*; D061226:Recurrent Laryngeal Nerve Injuries; D013961:Thyroid Gland / Q000033:anatomy & histology*; D013965:Thyroidectomy; D014826:Vocal Cord Paralysis
keywords: Anatomy; Meta-analysis; Recurrent laryngeal nerve; Thyroidectomy; Zuckerkandl’s tubercle