Oropharyngeal lipomas are rare tumours. We present the case of a young man with an asymptomatic lipoma almost completely occluding his supraglottic airway, found on magnetic resonance imaging (MRI) for a separate oral cavity lesion. Pre-operative anaesthetic assessment was undertaken because of the risk of airway obstruction at induction of general anaesthesia. We discuss the awake fibre-optic technique used for induction, as well as the treatment and follow-up of these tumours. This case highlights the need for formal anaesthetic assessment, in such cases, to avoid total airway obstruction at induction of general anaesthesia. It also emphasizes the extent of supraglottic obstruction that can be present without giving rise to any symptoms.