Lipoma is a benign tumour of mesenchymal origin with a very rare occurrence in the upper aero-digestive tract. To date, approximately 100 cases have been described in the literature. This lesion has a slow growth and, therefore, can present with various symptoms due to the mass effect with obstruction and compression on neighbouring structures, including dysphagia for liquid and solid food, dyspnoea and hoarseness. For a precise pre-operative diagnosis, indirect or direct laryngoscopy (flexible fibre-optic laryngoscopy) can be employed or, if necessary, also imaging techniques such as computed tomography scan and magnetic resonance imaging scan. These offer more useful information for better treatment planning. Surgery is the treatment of choice and includes endoscopic techniques and an external surgical approach (cervicotomy). It is very important to completely remove these benign neoplasms in order to avoid local recurrence. The present report refering to a case of laryngeal lipoma removed through an external surgical approach, aims to demonstrate that the choice of an external surgical approach is required for complete surgical removal of a large lipoma in order to prevent any possible recurrence. Furthermore, it is useful to keep in mind the possibility of recurrence of lipomas after long free intervals; therefore, it is mandatory to observe these patients at long-term follow-up
