title: Atypical location of the hypoglossal nerve and its implications: a case report.
abstract: BACKGROUND
  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.
authors.affiliation: Wake Forest School of Medicine, 1 Medical Center Blvd, Winston-Salem, NC, 27103, USA. matt.rohlfing@gmail.com.
authors.forename: Matthew L
authors.identifier: http://orcid.org/0000-0002-8744-4098
authors.initials: ML
authors.lastname: Rohlfing
authors.affiliation: Wake Forest School of Medicine, 1 Medical Center Blvd, Winston-Salem, NC, 27103, USA.
authors.forename: Joshua D
authors.initials: JD
authors.lastname: Waltonen
mesh_terms: D005260:Female; D006801:Humans; D007002:Hypoglossal Nerve / Q000002:abnormalities*; D008875:Middle Aged; D037981:Neck Dissection; D013965:Thyroidectomy
keywords: Cranial nerve; Endarterectomy; Hypoglossal; Neck anatomy; Neck dissection