Background <p>Retropharyngeal masses are uncommon head and neck masses. Early identification is necessary because of the location, which renders even benign lesions potentially fatal. Early clinical diagnosis remains challenging. Magnetic Resonance Imaging (MRI) is the investigation of choice, although final histological confirmation is essential. It is crucial to include them in differentials for early diagnosis because of their uncommon incidence and diverse clinical presentation.</p> Case presentation <p>We present the case of a 22-year-old, male of Indo-aryanethnicity presenting with compressive symptoms due to a massive retropharyngeal lipoma extending bilaterally into carotid space. Flexible nasal endoscopy revealed a mass arising from the oropharynx, obscuring the view of laryngeal structures. Magnetic Resonance Imaging suggested the diagnosis of retropharyngeal mass. The tumor was surgically removed by transcervical approach and the patient had an uneventful recovery. The histological examination confirmed the diagnosis. A literature search was conducted in all major medical databases where male predominance was found. Dysphagia was the most common symptom, followed by snoring. The most used imaging modality was Computed Tomography. Surgery was the treatment in most of the cases with transcervical approach in majority. Complete recovery was reported, following treatment in the majority of cases.</p> Conclusions <p>Retropharyngeal lipomas are uncommon head and neck tumors that, with early diagnosis and treatment, can have favorable outcomes. When assessing retropharyngeal mass, it is crucial to maintain them in differential.</p>