Lipoma of the temporal region: a rare case series

Abstract

Lipomas are common benign tumours that can occur in most parts of the body. Lipomas arising from the deep temporal fat pad, found between the two layers of the deep temporal fascia, are rare, however; there has been only one documented case report to our knowledge. We describe a second case arising from the temporal fat pad in a patient treated at our unit, having previously reported the first one, and discuss the relevant anatomy and management.

Case history

A 75-year-old woman presented with a slowly enlarging mass in the left temple. She also reported recent headaches and blepharospasm of the left eye. Examination found a 3×3cm soft mass palpable above the left zygomatic arch. Computed tomography (CT) showed a low attenuation mass superficial to the temporalis muscle that extended from the temporalis insertion to the infratemporal fossa, in keeping with a radiological diagnosis of lipoma (Fig 1).

Figure 1.

Computed tomography scan showing a low attenuation mass superficial to the temporalis muscle that extends from the temporalis insertion to the infratemporal fossa

At operation, the lipoma was found to be deep to the superficial leaf of the deep temporal fascia (Fig 2). Therefore an Al-Kayat–Bramley approach¹ was used to gain access to the lipoma deep to the fascia to preserve the frontal (temporal) branch of the facial nerve. The lipoma was removed with sharp and blunt dissection. The patient made a full recovery, with no facial nerve weakness. Histology confirmed a completely excised lipoma. At review, the patient’s headaches and blepharospasm had resolved.

Figure 2.

Intraoperative photo showing the lipoma deep to the superficial leaf of the deep temporal fascia

Discussion

This case would appear to be only the second report of a lipoma arising between the two layers of the deep temporal fascia in the fatty syracusis between them.² The anatomy of the temporal region is shown in Figure 3. Given that there is a fatty pad in this region, it is not surprising that lipomas could arise in this site, although this seems to be very rare. In addition to adding to the literature, this case reminds surgeons of the temporal anatomy, particularly regarding the location of the facial nerve. Dissecting in the plane of the deep fat pad protects the facial nerve during approaches to the arch and temporomandibular region. Additional studies indicate the significance of identifying the temporal fat pad when the fascia is split for facial nerve protection.³ This is a simplification, as there are three fat pads between the deep and superficial layer of the temporal fascia, each of varying thickness. As seen in our rare case, a lipoma can potentially occur in any of these fat pads.

Figure 3.

Anatomy of the temporal region