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Anatomical variants of the spinal root of the accessory nerve and cervical plexus are well known but other variants are exceptionally rare. A prospective study of 160 selective neck dissections was undertaken following an index case, where a presumed C1 nerve (travelling with the hypoglossal nerve) was found to innervate sternocleidomastoid (SCM). A search was subsequently made for this variant while not compromising the neck dissection surgery itself. Eight cases could not be included due to metastatic disease precluding safe dissection in this area. A nerve stimulator was used to confirm the motor supply to SCM. This nerve variant was found in 4/160 necks (2.5 %). In all cases, it originated directly from the hypoglossal nerve and stimulation resulted in isolated SCM contraction. No accessory nerve anomalies were found. This finding adds to the knowledge of variants in this area. Meticulous dissection and preservation of all nerves, where possible, is important for optimising functional outcomes following surgery.

We present a rare, and to the best of our knowledge, previously unreported complication of the spontaneous rupture of an internal laryngocele after a routine neck dissection for metastatic squamous cell carcinoma. While this caused some diagnostic confusion, the patient was managed conservatively with no further complications.