Background: Lipoma is a very rare benign tumour of upper aero-digestive tract with less than 115 cases described in the English-literature. They account for approximately 1% of benign tumours of the larynx and oro/hypopharynx. The symptoms are variable including progressive horseness, dysphagia and even severe dyspnea which can sometimes be life-threatening. The clinical presentation of lipoma is important particularly during the induction of general anesthesia, for they can cause unpredictable airway obstruction. Surgery is the treatment of choice which includes endoscopic techniques, microscopic laryngeal surgery and external surgical approach (cervicotomy). However, a standard surgical management for large lipomas of the epiglottis has not been present yet. In this article, we present a case report of a huge lipoma of the epiglottis successfully treated with tracheotomy and external surgical approach—cervicotomy with hyoidthyroidpexy without sacrificing any laryngeal structure. Case Presentation: We present a case of a 54-year-old female with a huge lipoma on the lingual surface of the epiglottis that extends upwards to the level of the left aryepiglottic fold narrowing the pyriform sinus, making impossible for our anesthesiologist the glottic visualization and the orotracheal intubation. Following a tracheotomy, the endoscopic and microscopic surgery approach was inadequate to manipulate the epiglottic lipoma. Instead, we performed macroscopic external surgery (cervicotomy with hyoidthyroidpexy) in which the epiglottic lipoma was pulled into the endolaryngeal window with forceps and then dissected from the surrounding tissues “in toto”. Conclusion: Despite epiglottic lipomas are rare and benign, they are important because of being potential cause of laryngeal obstruction. Surgery is the treatment of choice and different procedures are able to manage it. The external surgery approach—cervicotomy with hyoidthyroidpexy after tracheotomy enabled the huge lipoma to be extirpated without leaving any remnants or causing excessive laryngeal damage.
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