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Lipoma is a benign, slow growing tumour composed of adipose tissue. In general, it is very unusual for lipoma to form in the head and neck region, let alone achieve a size of more than 10 cm with the involvement of deep neck spaces. We discussed a case of an extremely huge neck lipoma measuring 18 cm x 14 cm with extensive involvement of deep neck spaces, infratemporal fossa and pharynx, closely adherent to submandibular and parotid gland. The diagnostic and therapeutic challenges were discussed, in achieving a surgically complete excision and cosmetically acceptable outcome. [ABSTRACT FROM AUTHOR]