Management of Circumferential Cervical Benign Symmetric Lipomatosis: A Case Report of Staged Surgical Resection

Benign symmetric lipomatosis (BSL), or Madelung disease, is a rare condition characterized by non-encapsulated, symmetrical adipose tissue accumulation. Although uncommon, circumferential cervical involvement can pose a life-threatening risk of airway obstruction. We report a 58-year-old Japanese man with chronic alcohol dependence presenting with progressive bilateral neck swelling, dysphagia, and nocturnal respiratory distress. Initial magnetic resonance imaging revealed 21 mm of adipose tissue at the C4/5 level. Following posterior cervical lipectomy and subsequent disease recurrence, imaging five years later demonstrated progression to 70 mm of circumferential adipose proliferation with impending airway compromise. A quadrant-based, four-stage open resection protocol was performed between March 2023 and February 2024, utilizing sequential lateral, anterior, and posterior approaches. This staged approach successfully avoided tracheostomy while removing approximately 2,100 grams of adipose tissue. At 16-month follow-up, cervical thickness reduced to 48 mm with complete resolution of dysphagia and respiratory symptoms. Residual submental laxity from platysmal diastasis and submandibular gland hypertrophy remained, though secondary procedures were deferred due to questionable alcohol abstinence evidenced by persistently elevated γ-GTP levels. This case demonstrates that systematic staged resection can safely manage circumferential cervical BSL while preserving airway integrity. However, sustained alcohol abstinence remains critical for preventing recurrence, and comprehensive functional assessments should guide future management protocols for this rare condition.