A 30-year-old Hispanic man presented with a 5-year history of a slowly enlarging, painful mass in the right side of his neck. The mass intermittently fluctuated in size and had been treated several times with antibiotics. The patient denied smoking, alcohol use, weight loss, cough, hoarseness, dysphagia, fever, chills, trauma, or drainage from the mass. The patient was evaluated by the Otolaryngology Service, where he was found to have a 3 × 2-cm firm, tender mass in the right submandibular area. The results of the remainder of the head and neck examination were within normal limits. A computed tomographic scan (Fig 1) revealed the 3-cm mass with extensive calcification abutting the hyoid bone and lateral pharyngeal wall. An excision of a mass from the subdigastric region was performed. The mass was firm and densely adherent to the pharyngeal wall, hyoid bone, and hypoglossal nerve. Frozen-section pathologic examination revealed no evidence