Variant configurations of the internal carotid artery (ICA), especially when curved in S-or C-shape, are often studied intracranially. 1 However, such abnormal siphons in the neck are less frequently explored for their clinical significance. 2 During neck dissection in cancer surgeries, this unexpected anatomy may predispose to devastating complications. We hereby discuss a case of an anomalous cervical ICA siphon impinging on the spinal accessory nerve (SAN) and its implication for the operating surgeon.A 52-year-old female patient with early tongue cancer underwent left wide excision glossectomy and selective neck dissection. While dissecting the SAN, we encountered a mass embedded in the lymphoadipose tissue in the Level II region. This appeared akin to a metastatic lymph node at the first glance. However, on palpation, the mass was found to be pulsatile and further dissection revealed it to be a tortuous ICA presenting as a curved siphon extending as laterally as the left SAN, coming to overly it (Fig. 1). Neck clearance, specifically of the Levels IIa and IIb, was done by careful blunt dissection and gently retracting the siphon with a thumb retractor avoiding undue pressure over the carotid. Meticulous hemostasis was secured at the end of the procedure. Rest of the intra-and post-operative course was uneventful.Aberrant curvatures of the extracranial ICA have been reported, but their clinical effect is underestimated. 3 Coiling and kinking
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