Retropharyngeal fibrolipoma: A counterchanging obstructive pattern in sleep apnea

Retropharyngeal fibrolipoma has rarely been reported as the cause of obstructive sleep apnea (OSA). The clinical presentation, diagnosis, and treatment of tumor-related OSA are vastly different from those of generic OSA. We report a case of retropharyngeal fibrolipoma in a 17-year-old boy. Our patient presented with snoring, daytime sleepiness, and difficulty in swallowing. Flexible fiberoptic nasopharyngoscopy revealed a smooth bulging mass in the retropharynx. Magnetic resonance imaging demonstrated a hyperintense, heterogeneous mass over the retropharynx. Transoral excision of the retropharyngeal tumor was performed and pathological examination proved the tumor to be a fibrolipoma. The apnea/hypopnea index decreased from 12.2 to 7.4 event/h after surgery with associated improvement in snoring, daytime sleepiness, and swallowing. When swallowing difficulty occurs in patients with OSA, the retropharyngeal obstruction should be considered in evaluating the patient.