| Summary: | Preoperative diagnosis of the presence of anomalies or abnormalities of the cervical vessels is important to safely perform neck dissection in patients with head and neck cancer. We present a case of cervical lymph node metastasis from carcinoma of unknown primary origin in a 72-year-old man. The patient had a huge lymph node metastasis in his right neck that was more than 90° adjacent to the common carotid artery. Imaging studies incidentally revealed right internal carotid artery hypoplasia. Internal carotid artery hypoplasia is a very rare vascular anomaly with an incidence of <0.01%. Previous reports have focused on the imaging findings and have not shown the macroscopic findings of a cervical hypoplastic internal carotid artery in a living patient. Intraoperative findings of the neck dissection in the present case showed that the hypoplastic internal carotid artery branched from the common carotid artery as a cord thinner than the vagus nerve, and no pulsation was observed. This is the first report of neck dissection in a patient complicated with internal carotid artery hypoplasia. Although this is a very rare condition, it is a vascular anomaly that should be considered by head and neck surgeons who routinely perform operations around the carotid artery.
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