Unilateral external jugular vein fenestration with variant anatomy of the retromandibular and facial vein

External jugular vein (EJV), a significant superficial vein draining head and neck (H&N) region is been increasingly used for cannulation in diverse diagnostic purposes and intravenous therapies. The variant anatomy of formation and draining patterns of EJV and retromandibular veins were reported earlier. In the present case, EJV showed significant variation in one of the male cadaver, during routine H&N dissection. On the left side, a fenestration of EJV was observed and the transverse cutaneous nerve of the neck was passing through the fenestration of the vein. Anatomical knowledge of EJV and retromandibular vein variations as found in this case is important for surgeons performing microvascular surgeries in H&N and also to the radiologists during their conventional radiological procedures like angioplasty, catheterization, and at times of hemodialysis in case of renal failure patients.