A 65-year-old man with a 2-month history of left-sided neck swelling presented through the cancer pathway. There was no associated 'red flag' symptoms, and clinical examination revealed a left anterior triangle, non-pulsatile firm swelling atypical of a lymph node. Ultrasound scan imaging confirmed a complex structure with an echogenic centre and hypoechoic periphery, which was confirmed on CT as an osteoma of the hyoid.This is an extremely unusual cause of a neck lump, and an extensive literature review revealed only two previously documented cases.