The histologically benign hypopharyngeal lipoma is a potentially fatal tumour because of the risk of upper airway obstruction. It may be asymptomatic or present with symptoms ranging from vague foreign-body sensation to sore throat, dysphagia or dysphonia. The diagnosis may be suggested by indirect or fibreoptic laryngoscopy. Lateral neck soft tissue X-ray and barium swallow may help but CT imaging of the pharynx enables a more precise preoperative diagnosis. Treatment is by surgical excision of the lesion either perorally, endoscopically or via a lateral pharyngotomy. Long-term follow-up is recommended due to the possibility of recurrence and metachronous lesions.