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 immediately 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.