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Introduction Foreign body cases are common in otolaryngologic practice, usually occurring in children. An impacted penetrating impaling foreign body can be one of the most challenging emergencies Management revolves around safe extraction of impaling object and prevention of complications. Here we share our experience with one such case of unusual foreign body impacted at an unusual site, with an extensive review of  literature discussing management & prevention of complications in similar cases. Case Report A 3 year old boy presented to us in ENT emergency with a long metallic hook impaled in nasopharynx for the past 8 hours.  We were able to dislodge the impacted foreign body under direct endoscopic visualisation under general anaesthesia. Discussion Any such injury might be similar but no two injuries are the same. It needs combined expertise of multidisciplinary team usually consisting of  ENT surgeon, anaesthesiologist, radiologist and may also need vascular surgeon and interventional radiologist at times. Several complications are reported in literature, knowledge of which would help preparedness and thus a better outcome.