Near-Complete Airway Obstruction from Parapharyngeal Lesion on TMJ Evaluation

A 61-year-old male with pain following third molar extractions was referred for evaluation of the TMJs and extraction sockets. During full-volume review, the radiologist identified a large soft tissue lesion of the right pharynx that was severely displacing and obstructing the patient's airway. Only a few millimeters of the airway remained patent at its narrowest dimension. The lesion was more suggestive of a very large parapharyngeal abscess, though a tumor could not be excluded.

Given the severity of the finding and the potential for complete airway occlusion, the radiologist called the referring practice. The case had been read on a Friday afternoon, and the referring doctor contacted the patient directly with instructions to go to urgent care. This case illustrates how full-volume review can identify findings far beyond the area of clinical concern that require immediate action.