Background <p>Accidental fish bone ingestion is a common occurrence in fish-eating populations; however, migration into the parotid space is exceptionally rare due to its anatomical protection. Such migration may mimic more common pathologies and lead to delayed diagnosis, resulting in deep neck space infections and cranial nerve dysfunction.</p> Case Presentation <p>A 70-year-old woman presented with a four-day history of left parotid–masseteric swelling, trismus, dysphagia, cough on swallowing, and deviation of the oral commissure following an episode of fish bone ingestion and self-removal attempts. Examination revealed left-sided facial palsy and hoarseness. Flexible nasoendoscopy demonstrated pooling in the left pyriform sinus and left vocal cord palsy, indicating concurrent facial and vagal nerve involvement. Contrast-enhanced CT revealed a 2.6 cm linear hyperdense foreign body within the left parotid gland, with multiloculated abscesses extending into the parapharyngeal and masticator spaces. The patient was managed with broad-spectrum intravenous antibiotics, strict glycemic control, and nasogastric feeding, followed by surgical drainage via a preauricular and intraoral approach. The foreign body could not be retrieved due to deep embedding in inflamed tissue. Anaerobic culture yielded Peptostreptococcus and Prevotella species. Postoperatively, the patient showed rapid clinical improvement with partial recovery of facial and vocal cord function and complete resolution of swelling at one-month follow-up.</p> Conclusion <p>Migration of a fish bone into the parotid gland with simultaneous facial and vagal nerve palsy is exceedingly rare. Early high-resolution imaging, timely surgical drainage, and multidisciplinary management are crucial for preventing life-threatening complications and achieving favorable neurological and functional outcomes.</p>