The typical course of the CNXII after emerging from the hypoglossal canal is medial to the internal jugular vein (IJV) and lateral to the carotid artery above the carotid bifurcation-a notably consistent relationship. 1 To our knowledge, a course of the CNXII lateral to the IJV has been reported in only 4 cases in the surgical literature. Anatomical dissection of 8 CNXIIs posterior to the internal jugular vein was published by Löwy in 1910. 2 This more exposed trajectory places the nerve at increased risk of injury and therefore is of particular interest to surgeons operating in the neck.

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