A 39-year-old man presented with recurrent attacks of sore throat, dysphagia, persistent halitosis, ear pain, and a hard swelling in the left submandibular region. He stated that he had had an episode involving similar symptoms 7 years earlier and that the mass had ruptured, causing an exudation of pus. His medical history was remarkable for 30 years of tobacco use.
Examination of the oropharynx revealed a large, immobile, hard swelling arising from the left tonsil. There was no trismus or mucosal ulceration. A tonsillar mass with restricted mobility was bimanually palpable behind the left angle of the mandible. A plain lateral neck radiograph (1) showed irregular dense opacities at the left angle of the mandible, extending well below the lower border of the mandible. The mass had no soft-tissue component. Computed tomography of the neck revealed a large bone density mass, measuring approximately 45 × 25 × 20 mm (vertical and anteroposterior and medial to lateral diameter) in the left tonsillar region, extending 1 cm inferior to the angle of the mandible (2 and 3). There was no clinical or radiologic evidence of lymphadenopathy. Treatment consisted of surgical exploration and removal of the mass.
Anand TS, Tatavarthy S, Kumar S. Radiology Quiz Case 2. Arch Otolaryngol Head Neck Surg. 2009;135(9):941. doi:10.1001/archoto.2009.134-a