Objectives <p>To report the incidental detection of a retained earring back on panoramic radiography, and to emphasise the importance of recognising extraoral foreign bodies in dentomaxillofacial imaging.</p> Methods <p>A panoramic radiograph was obtained as part of a routine preoperative assessment prior to the extraction of a third molar in a 33-year-old woman. The image showed a well-defined, round, radiopaque object over the right auricular region. Clinical examination and patient history were reviewed to determine the origin of the finding.</p> Results <p>A focused examination revealed a firm subcutaneous nodule in the posterior earlobe with a faint metallic sheen visible beneath the skin. The patient reported having her ears pierced in childhood and recalled experiencing intermittent pain over the subsequent four years. It had previously been diagnosed as a keloid by an ear, nose and throat (ENT) specialist. She had remained asymptomatic for two decades and was unaware of any retained foreign body. Under local anaesthesia, a small incision was made in the posterior earlobe, and an intact metallic earring back was retrieved from the subcutaneous tissue. Postoperative recovery was uneventful, with complete healing observed at the follow-up appointment.</p> Conclusions <p>Incidental findings on panoramic radiographs may reveal clinically extraoral foreign bodies. It is essential to be aware of their potential appearance and to be able to differentiate them from intraoral or osseous structures, to prevent diagnostic confusion and unnecessary further investigation. This case highlights the importance of correlating radiographic findings with clinical examination to determine the true nature and location of unexpected opacities.</p>