What is the cause of persistent posterior neck pain one week post-operative tonsillectomy (tonsil removal) in an afebrile patient with no neutrophilia (elevated neutrophil count)?

Differential Diagnosis for Posterior Neck Pain 1 Week Post-Operative Tonsillectomy

• Single Most Likely Diagnosis
  • Muscle strain or spasms: This is a common cause of neck pain after surgery, especially if the patient has been in an awkward position during recovery or has been using their neck muscles more than usual to compensate for discomfort or difficulty swallowing.
• Other Likely Diagnoses
  • Hematoma formation: Although the patient is afebrile and has no neutrophilia, a hematoma could still be causing the neck pain, especially if it's small and not causing significant systemic symptoms.
  • Infection (e.g., abscess, cellulitis): Despite the lack of fever and neutrophilia, a localized infection could still be present, particularly if the patient is taking antibiotics or has a partially treated infection.
  • Styloid process fracture: This is a rare but possible complication of tonsillectomy, especially if the patient has had significant trauma or manipulation of the neck during surgery.
• Do Not Miss Diagnoses
  • Carotid artery dissection or pseudoaneurysm: These are rare but potentially life-threatening complications that could cause neck pain, and it's essential to consider them in the differential diagnosis, even if they are unlikely.
  • Cervical spine injury or instability: Although unlikely, a cervical spine injury could have occurred during intubation or surgery, and it's crucial to rule out this possibility, especially if the patient has any neurological symptoms.
  • Retropharyngeal abscess: This is a serious and potentially life-threatening condition that requires prompt diagnosis and treatment, even if it's unlikely in this scenario.
• Rare Diagnoses
  • Eagle syndrome (stylohyoid ligament calcification): This is a rare condition that could cause neck pain, especially if the patient has had trauma or manipulation of the neck during surgery.
  • Cervical osteomyelitis or discitis: These are rare infections that could cause neck pain, especially if the patient has a history of recent spine surgery or instrumentation.