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A Patient With Cervicalgia.

A man in his 60s with a 20 pack-year smoking history presented with a several-month history of intermittent left otalgia, facial pain, swelling, and dysphagia. The pain was exacerbated by eating and prolonged talking. He was initially seen at an emergency department, where his symptoms were unsuccessfully treated with antibiotics. He stated that he had not experienced hoarseness, weight loss, fever, night sweats, parotid mass, or involuntary facial nerve spasms. His medical history was significant for blunt trauma to the left maxilla region approximately 10 years prior to presentation. His surgical history was noncontributory. Physical examination demonstrated a well-developed man in no distress who spoke in a normal tone. His vital signs were normal. The external auditory canals and the tympanic membranes were intact and clear bilaterally. The nasal cavity and the nasopharynx were normal. The oral cavity and oropharynx revealed moist mucosa with no lesions or erythema. Fiber-optic flexible nasopharyngoscopy and laryngoscopy revealed normal pharyngeal walls and pyriform sinuses. The vocal folds were symmetric and mobile bilaterally. Computed tomography (CT) of the neck demonstrated a ossified mass (arrowheads) in the left parapharyngeal space (Figure). Quiz at jamaotolaryngology.com Axial view A Sagittal view B Coronal view C