Lipoma in the Oral Cavity: A Rare Entity

ABSTRACT

Lipoma is a painless soft tissue tumor of mesenchymal origin, which is a well-defined and slow-growing tissue. The occurrence of lipoma is rare in the oral cavity (1–4%); however, the frequency is much higher in the head and neck region. The lipoma is commonly present in the buccal mucosa, lips, tongue, palate, buccal sulcus, and floor of the mouth. Sometimes, the lipoma becomes large enough to cause difficulty in speech and mastication. The main treatment for lipoma is surgical excision.

INTRODUCTION

Lipoma is a benign tumor of fat. It represents by far the most common mesenchymal neoplasm, and most cases occur on the trunk and proximal portions of the extremities; however, lipomas of the oral and maxillofacial region are rare.[1] Their overall incidence in the oral cavity is thought to be less than 4.4% of all benign oral mesenchymal neoplasms.[2,3,4] Oral lipomas may occur in various anatomical sites including the major salivary glands, buccal mucosa, lip, tongue, palate, and floor of the mouth. Of these, the buccal mucosa and buccal vestibule are the most common intraoral sites and account for approximately 50% of all cases.[4] Small lipomas in the intraoral cavity may be asymptomatic, but large tumors may cause discomfort, difficulty chewing, dysphagia, and dyspnea. Typically, there is no pain or tenderness.

Etiology

The etiology of oral lipoma is unclear. Some studies have acknowledged that mechanical factors, endocrine system, inflammation, obesity, chromosomal abnormalities, radiation, trauma, mucosal infections, and chronic irritation can contribute to the development of oral lipoma.[5] The rate of recurrence is 1 to 2%.[6] Here, we report a case of intraoral lipoma on the mandibular buccal vestibule treated by surgical excision.

CASE REPORT

A 46-year-old woman was referred to the Department of Periodontology with the chief complaint of swelling in the right lower region of the jaw. Upon examination, there was gingival swelling that started one year prior. The patient also complained of discomfort while eating. Upon intraoral examination, we observed the swelling was in relation to the right first premolar mandibular vestibule. On palpation, the nature of the swelling was mobile, soft, and nontender. Intraorally, it presented as a pinkish, oval swelling in the buccal right sulcus in relation to 45 and 46 regions [Figure 1]. The patient did not complain of any pain when the mass was palpated. The covering mucosa was normal in texture without any signs of inflammation and ulceration. The mass measured was approximately 10 × 11 mm by using a University of North Carolina (UNC-15) probe, manufacturer by HuFriedy group periodontal probe [Figure 2]. An excision biopsy was planned under local anesthesia. First and foremost, the tissue mass was clamped with artery forceps, so that proper incision will be carried out and healing will be better postoperatively [Figure 3]. Blade no. 15 was used for excision [Figure 4]. The excised specimen was [Figure 5] then sent for histopathological examination. The lesion was capsulated and completely dissected [Figure 6]. The histopathological examination revealed an adipose tissue and a thin capsule surrounding the lesion and pathologic diagnosis showed an intraoral lipoma. There were no complications during and after the surgery and no sign of recurrence after 12 months. A review after 7 days showed uneventful healing. Her medical history was noncontributory. We did not notice any masses at other sites in the intraoral cavity and submandibular lymph nodes were not swollen or tender.

Figure 1.

Preoperative view of lipoma

Figure 2.

Lipoma measuring 10 mm x 11 mm

Figure 3.

Tissue held with artery forcep

Figure 4.

The tissue mass clamped with artery forceps at the base for better incision

Figure 5.

Excised specimen

Figure 6.

Postoperative view after excision of tissue

DISCUSSION

Lipomas are benign tumors that can occur in any part of the body, commonly seen in the head and neck region. Lipoma can be found in both soft and bony tissues. Intraoral lipomas are rare, the studies’ statistical analysis shows only 1 to 4% affecting these sites.[7,8] Furlong et al. found only 125 cases of lipomas occurring in the oral cavity over a period of 20 years, which again shows the uncommonness of these oral tumors.[9] Lipomas can occur in patients of all age groups and are more common in females than males.[10] The most common locations of lipoma in the oral cavity have been reported to be in the buccal mucosa followed by the tongue, which is seen in our patient having the lesion in the buccal mucosa.[11] Complete surgical excision is the main treatment of lipoma. This treatment is best done on lipomas that are less than 1 inch in diameter. A monthly repeated injection of 1:1 mixture of lidocaine and triamcinolone acetonide into the central part of lipoma may be useful in regression of lesion. The average volume of steroid used may range from 1 to 3 mL depending on the size of the lipoma. A 16-gauge needle and large syringe are useful in small or large tissue growth where scarring should be avoided.[12]

CONCLUSION

Intraoral lipomas are a rare entity that may be noticed most of the time during routine dental examinations. Many of them rarely cause pain, resulting in delays in seeking treatment by the patients. The patient’s concerns may be regarding esthetics or discomfort during mastication. It is mandatory for a clinician to diagnose intraoral lipomas using the latest diagnostic methods and conservatively treat them without causing much discomfort.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.