Fish bone ingestion is a common presenting complaint to the Otorhinolaryngology clinic. In majority of the cases, the removal of visualised impacted fish bones is fairly straightforward. However, diagnostic dilemma may arise in cases of migratory fish bones as initial examination may be unsuspecting. Computed tomography (CT) of the neck has proven to be a valuable tool in identifying the presence of such foreign bodies. However, there is also a subset of patients who are asymptomatic as the fish bone migrated extra-pharyngeally and they may only present late with potentially grave consequences. Herein, we present a case of elderly female with history of fish bone ingestion who presented to us eight months later with primary complaint of huge swelling in the left side of the neck. Subsequent investigation unravelled the diagnosis of migratory fish bone causing an extensive foreign body reaction resulting in a huge granuloma. The fish bone was successfully removed with subsequent resolution of the neck swelling.