The omohyoid muscle is frequently encountered during anterior cervical spine surgery, particularly at the C5-C7 levels, yet it has received limited emphasis in spinal literature. Its superior belly often crosses the operative corridor, leading surgeons to choose between preservation, retraction, or sectioning. This narrative review synthesizes anatomical and clinical evidence regarding omohyoid variability, surgical handling, and postoperative outcomes in anterior cervical discectomy and fusion procedures. Anatomical studies reveal substantial muscle variation, including accessory slips and aberrant insertions, which can influence exposure. Emerging clinical data suggest that sectioning the superior belly when obstructive improves visualization and may reduce operative time and blood loss without significantly increasing dysphagia, dysphonia, or cosmetic concerns. However, prospective studies with standardized outcome measures remain limited. Understanding this "forgotten anatomy" may enhance operative planning, optimize exposure, and refine technique in lower cervical approaches.