Retropharyngeal lipoma with parapharyngeal extension: is transoral excision possible?

Retropharyngeal lipomas are rare tumours that are usually asymptomatic until they reach a large size. The definitive treatment is surgical excision. Since the tumours are typically large at the time of presentation, extensive surgery for complete clearance of the lipoma from the retropharyngeal and parapharyngeal regions is to be expected. Transoral excision is typically indicated for small retropharyngeal tumours, as this approach does not give good access to the parapharyngeal area laterally. Herein, we present the case of a patient who underwent transoral excision of a huge retropharyngeal lipoma, which extended into the right parapharyngeal space. The surgical technique used and the insights gained are described in this report. Even with parapharyngeal extension, transoral resection of a huge retropharyngeal lipoma can be performed. More invasive surgery, which may involve a neck incision, mandibulotomy or pharyngotomy, is not necessary. While huge retropharyngeal lipomas are usually symptomatic and require surgical intervention, transoral resection can be adequate and safe for treatment.