Lipomas, tumors of adipose tissue, are common and make up 16% of tumors of mesenchymal origin. Approximately 25% of lipomas occur in the head and neck region and are commonly found subcutaneously in places, such as the posterior neck. 1 The prevalence is higher among men than women, and often arise in the fifth or sixth decade of life. 2 Lipomas can further be categorized based on their histopathology into variants such as angiolipoma, chondrolipoma, spindle cell lipoma, or, in our case, osteolipoma. 1 An 81-year-old Caucasian male complaining of dysphagia associated with weight loss of 2 years duration was referred to the otolaryngology office after magnetic resonance imaging (MRI) of the brain demonstrated a hyperintense retropharyngeal mass with smooth margins measuring 4.46 cm  2.35 cm in sagittal view (see Figure 1). The MRI was originally ordered for cognitive complaints. Nasopharyngeal fiber-optic examination revealed a large mass in the left posterior pharyngeal wall partially obstructing the airway. No mucosal ulceration was noted, and the true vocal folds demonstrated full range of motion. A computed tomography (CT) scan of the neck with contrast