A Curious Case of Persistent Throat Pain—Bone Fragment in th
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A healthy man in his 20s, with a history of tonsillectomy for recurrent tonsillitis, presented to clinic with a 3-month history of persistent, severe, right-sided, throbbing throat pain and dysphagia. He was treated by a physician with multiple courses of antibiotics and steroids, with marginal improvement. Initial (CT) scan of the neck showed a calcification in the right parapharyngeal space (PPS). The patient subsequently underwent magnetic resonance angiography of the neck, which was unremarkable.

The decision was made to explore the right peritonsillar and PPS intraorally. There were no intraoperative findings and the patient continued to experience discomfort. Given his persistent severe symptoms and radiologic findings, the decision was made for a transcervical exploration of the right PPS.

Intraoperatively, the stylomandibular ligament was neither visualized, nor palpable. In the area of the radiologic calcification, a 7-mm bony mass was located along the course of the expected stylomandibular ligament above the digastric tendon. Final pathologic analysis of the specimen was consistent with benign bone and associated fibroconnective tissue. At 1 and 4 month follow-ups, the patient noted complete resolution of symptoms and postoperative CT showed no remaining bone in the right PPS.

Source: https://jamanetwork.com/journals/jamaotolaryngology/fullarticle/2769197
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