Meticulous history taking and careful examination should always be performed in all patients because a common symptom, such as sore throat, could be a presentation of an unusual problem. Sore throat from an ingested foreign body can perforate the mucosa and migrate extraluminally penetrating vital structures of the neck. Rare documentation of such cases involves sharp objects and, if untreated, may result in life-threatening complications. This article presents a case of a patient with a 3-week history of sore throat, and diagnostic work-up revealed a sharp metallic foreign body (needle pin) in the hypopharynx, which migrated extraluminally through the posterior pharyngeal wall. There were no signs or lesions on endoscopy to help point the exact entry point and location of the foreign body. Intraoperative imaging using C-arm was used to identify the exact position of the foreign body, which was at the level of C4, 0.5 cm deep to the right lateral posterior pharyngeal wall mucosa, and oriented lateral to the vertebra. The needle pin was subsequently extracted.