Carotid artery pseudoaneurysms are detected most commonly after acute traumatic injuries to the head and neck. Pseudoaneurysms of the carotid artery are rare after blunt trauma. The most common site of injury occurs in the internal carotid artery with greater than 70 per cent of those injuries resulting from motor vehicle collisions. We report a case of external carotid artery pseudoaneurysm secondary to chronic arterial trauma. The patient presented with a one-week history of left ear pain and a pulsatile left neck mass. Radiologic studies revealed a 2.8-cm neck mass compatible with a pseudoaneurysm of the external carotid artery. Primary repair of the aneurysm was performed. Exploration of the pseudoaneurysm cavity at the time of surgery revealed a fracture of the hyoid bone. We believe this to be the contributing factor to the formation of a pseudoaneurysm in this patient. This is the first reported case of external carotid pseudoaneurysm caused by chronic arterial injury secondary to hyoid bone fracture.