The omohyoid muscle has an intermediate tendon that passes through a fibrous sling or pulley attached to the clavicle and first rib, creating the characteristic angle of the omohyoid. This fibrous sling-tendon assembly represents the functional tendinous component of the omohyoid at the ansa cervicalis level.
The omohyoid intermediate tendon and its fascial sling are exposed during anterior cervical approaches and neck dissections. The tendon may need to be divided and repaired to provide adequate surgical access. It serves as a surgical landmark for the carotid sheath. Omohyoid muscle hypertrophy producing a visible neck mass with head rotation is a benign condition sometimes requiring surgical excision.
Enlargement of the omohyoid at its intermediate tendon producing a visible neck mass during contraction, a benign variant managed by reassurance or surgical excision for cosmetic concerns.
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