A 62-year-old woman presented to the general surgeryclinic for evaluation of an anterior neck mass. Shecomplained of hoarseness and dysphagia to both solid andliquids. Significantly, at the time of initial evaluation, thepatient wasunable totolerateflexiblelaryngoscopy.Thyroidexamination found significant enlargement with extensionbelow the sternal notch. On the basis of this clinical picture,total thyroidectomy was elected. Triple endoscopy wasperformed in the operating room demonstrating normalanatomy throughout. The operating surgeons made specificnoteoftheidentificationandsparingofboththesuperiorandrecurrent laryngeal nerves on the right side but made nocomment about the left superior laryngeal nerve. Theprocedurewas otherwise unremarkable,andthe parathyroidswere reimplanted into the sternocleidomastoids bilaterally.The patient was discharged on postoperative day 2 withoutnotable complications.At a follow-up appointment 1 week status afterthyroidectomy, the patient complained of continued dyspha-giaandhoarsenessaswellasasensationof“tightness”inherthroat.At1monthoffollow-up,thepatientbegantodescribesevereepisodicodynophagia.Codeine-acetaminophen5/325was trialed unsuccessfully for pain control. Further workupwas pursued, including requested consultation with 3separate specialties. Several attempts were made to visualizeanylesions, including computed tomographicimaging of thechest and neck as well as repeat flexible laryngoscopy. Allproved negative. Over a half-dozen separate diagnoses wereconsidered. The final service consulted was otolaryngology,after symptoms had persisted 7 months postoperative.Initial otolaryngology (ENT) evaluation, in fact, revealedprogressive worsening of all symptoms since the beginningof treatment. Odynophagia had replaced dysphagia as themost prominent symptom. Pain was exacerbated by food ateither extreme of temperature. There was accompanyinghoarseness.Onthesuspicionofalaryngealpathogenesis,thepatient was scheduled for evaluation by speech pathology.Their examination revealed maximum phonation time thatwas significantly below age-adjusted average, apparentlybecause of spasm of some sort. The patient was alsoobserved to have significant difficulty handling her secre-tions secondary to pain. However, a barium study demon-strated functionally normal swallowing.By this point, the patient had lost 30 lb secondary tosevere odynophagia in spite of adherence to a puree diet. Inlightoftherepeatednormalworkups,we,atthispoint,beganto suspect a cranial nerve neuralgia and trialed gabapentin300 mg bid. The patient reported a 50% symptom reductionon gabapentin at follow-up. Physical examination at thattime demonstrated tenderness in the middle portion of thethyrohyoid membrane. Injection of 0.5 mL 1% lidocaine atthe right superior laryngeal nerve was trialed. The patientreported relief within 30 seconds of administration. Fourmonths after the trialed nerve block, the patient reports thather pain is still well-controlled with continued use ofgabapentin. She is now tolerating a normal diet and hasregained 17 lb.Characteristics of superior laryngeal neuralgia have beendescribed as an idiopathic syndrome of paroxysmal pain