Treatment options in benign symmetric lipomatosis madelung's disease

Benign symmetric lipomatosis (BSL) is a rarely encountered disease first described by Brodie in 1846 [1]. Brodie's description was that of a single patient with symmetric cervical fat deposition. It was not until 1898 that Madelung [2], in a study involving 35 patients, described a classic distribution of fat, including a cervical horse collar distribution. Launoise and Bensaude, in 1898 [3], in an extensive review of 65 patients gave a more complete description of the entity as being diffuse and disseminated with characteristic fatty neck deposits. Several forms of the disease have been described; however, Type I is the most common presentation, with a specific fat collar composed of tissue that accumulates in the upper back and neck (Fig. 50.1). This form typically affects middle-aged men of Mediterranean heritage. Cosmetic deformity and limitation of mobility due to swelling of the neck are usually the first presentations of lipomatosis [4]. More advanced deposits of fat can cause extrathoracic airway obstruction and dysphagia. Sixty to ninety percent of patients with Type I BSL have a strong history of alcohol abuse and dependence [5].