Lipomas are the most common soft tissue mesenchymal neoplasms are uncommon in the oral and maxillofacial region. Oral lipomas usually exhibit slow asymptomatic growth and are less than 20 mm at their largest diameter. A 71-year-old man was referred to our regional oral and maxillofacial department by a dentist after noticing an asymptomatic tongue swelling. Examination and further radiographic and histological investigations revealed a large tongue lipoma which had been present for over three years. Initially it was decided to keep this benign lesion under review. However its relatively rapid growth over the next six months started to affect his speech, eating and airway and was subsequently removed surgically under general anaesthetic. This unusual case report documents the presentation, diagnostic considerations and treatment of this lipoma. It also highlights the important role clinicians have in detecting and investigating or referring any abnormal pathology.