Tuberculosis (TB) is an infectious disease caused by slow growing, acid fast, aerobic mycobacterium and has become the leading cause of death from a single infectious disease. Primary extra‐pulmonary TB lesions may arise as swellings in the head and neck, and can pose challenges of diagnosis and management to healthcare professionals. We present an unusual case of primary extra‐pulmonary TB manifesting as a fluctuant swelling of the fronto‐temporal region of the head and discuss value of special tests, such as fine needle aspiration cytology, microbiology and histopathology, with reference to previous case reports of TB in the head and neck.