AbstractAlthough approximately 13% of lipomatous tumors occur in the head and neck, most of these are found in the immediate subcutaneous tissues, and lipomas of the deep head and neck tissues are rare. Lipomas consist of adipose tissue separated by fine fibrous trabeculae; if the amount of fibrous tissue is appreciable, the designation of fibrolipoma is used. We describe an unusual case of a parapharyngeal fibrolipoma with airway narrowing and ipsilateral compromise of the carotid artery and internal jugular vein blood flow. Diagnosis of deep head and neck lipomata is facilitated by utilizing computed tomographic analysis and angiography. The transcervical approach to the skull base which allows complete resection of this lesion is described.