Madelung's disease is a benign disorder characterized by the presence of lipomata in the head and neck areas. It is disfiguring for the sufferer and is usually asymptomatic. Dysphagia and airway obstruction are rare presentations. Early surgical excision is recommended to exclude sinister pathology and to improve patient function. This is the first report (according to our literature search) of a patient who presented with dysphagia and obstructive sleep apnoea and in whom surgical intervention resulted in an improvement in both these symptoms.