Atypical location of the hypoglossal nerve and its implications: a case report

Introduction: Successful surgery in the neck is dependent on reliable anatomical relationships between nerves, vessels, and muscles. These landmarks and planes are also essential to avoiding undue morbidity and mortality. Anatomic variants of the hypoglossal nerve are rare, and their incidences are unknown. Methods: We describe a case of a hypoglossal nerve found coursing superficial to the internal jugular vein in a 52-year-old woman treated with bilateral selective neck dissection for metastatic thyroid malignancy. Results: The vulnerable nerve was protected, and she maintained excellent speech and swallow function post-operatively. Conclusions: The variant course of the nerve may pose higher risk for injury in neck surgery. Surgeons should be aware of the possibility of aberrant anatomy in this region and exercise extra caution to avoid nerve injury.