title: Upper airway study should always come before any sleep study in OSAS evaluation: a giant parapharyngeal lipoma behind OSAS.
abstract: BACKGROUND
  The parapharyngeal space (PPS) is a rare site for neoplasms in the head and neck and lipoma represents 0.5% of all head and neck tumors.
  
  
  METHODS
  We describe a case of a giant parapharyngeal lipoma in obese adult patient causing anatomic pharyngeal obstruction with severe obstructive sleep apnea (OSA) syndrome. The patient was successfully operated with transcervical approach.
  
  
  CONCLUSIONS
  In patients presenting with symptoms suggestive of OSA, it is essential to rule out any physical cause and perform a comprehensive ear, nose and throat examination including fibro-endoscopic upper airway examination before referral for sleep study and management. The ideal management for OSA involves treating the underlying cause. If no definitive cause is identified, management should begin with conservative measures such as lifestyle changes and a weight loss program; if these are unsuccessful, continuous positive airway pressure (CPAP), oral appliances or upper airway surgery could be considered. Better diagnostic methods should be developed to identify the main OSA causes and improve therapeutic outcomes.
authors.affiliation: Campus Bio-Medico University, School of Medicine, Rome, Italy. m.casale@unicampus.it
authors.forename: M
authors.initials: M
authors.lastname: Casale
authors.forename: F
authors.initials: F
authors.lastname: Salvinelli
authors.forename: C A
authors.initials: CA
authors.lastname: Mallio
authors.forename: V
authors.initials: V
authors.lastname: Frari
authors.forename: B
authors.initials: B
authors.lastname: Vincenzi
authors.forename: F
authors.initials: F
authors.lastname: Bressi
authors.forename: C C
authors.initials: CC
authors.lastname: Quattrocchi
mesh_terms: D000368:Aged; D006801:Humans; D008067:Lipoma / Q000150:complications* / Q000473:pathology; D008279:Magnetic Resonance Imaging; D008297:Male; D010610:Pharyngeal Neoplasms / Q000150:complications* / Q000473:pathology; D020181:Sleep Apnea, Obstructive / Q000175:diagnosis*