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Case Report
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1. INTRODUCTION
Lipomas are the most common benign mesenchymal
tumors occurring in humans and are predominantly
composed of mature adipocytes. Lipomas mainly
occur in various parts of the body, such as the trunk
and proximal regions of the extremities, but are
uncommon in the oral cavity. These entities represent
a mere 1–5% of all benign oral tumors [1], but they
present unique diagnostic and therapeutic challenges.
Lipomas in the oral cavity do not exhibit a predilection
for any specic location, and occurrences have been
reported in areas such as the tongue, buccal mucosa,
and oor of the mouth. They tend to occur in patients
between the ages of 40 and 60, with the average age
of occurrence being approximately 52 years, although
they can appear at any age.
Histologically, oral lipomas present in a spectrum of
subtypes, including but not limited to simple lipomas,
brolipomas, spindle cell lipomas, intramuscular or
inltrating lipomas, and angiolipomas. Each subtype
exhibits distinct histopathological features, whose
identication is critical for accurate diagnosis and
appropriate management.
Clinically, oral lipomas often present as asymptomatic,
slow-growing masses that may be overlooked or
misdiagnosed due to their subtlety and benign nature.
This report describes a case involving an adult female
patient who underwent successful surgical removal
of an intraoral lipoma.
2. CASE PRESENTATION
A 29-year-old woman presented at the Oral and
Maxillofacial Surgery Department at HUBruxelles
Erasme with a history of intermittent left cheek
swelling for several years (Fig. 1).
She was rst admitted without appointment, as she
described a sudden onset of cheek swelling that
could be compatible with cellulitis. The patient had
no notable medical history or medication usage to
report but disclosed that she smoked approximately
10 cigarettes daily. The patient's oral hygiene was
found to be excellent, no cavities were observed, and
no pain was elicited during dental percussion.
Moreover, an orthopantomogram revealed no
signicant lesions. Blood work showed no elevation
in white blood cells, C-reactive protein (CRP), or other
relevant markers of infectious or allergic origin. A
OPEN ACCESS This is an Open Access article under the CC BY-NC 4.0 license.
Peer-Reviewed Article
Citation: Keddar M, et al. Politis C. Large Mandibular Lipoma: A Case Report. Stoma Edu J. 2024;11(1-2):78-81.
Received: February 18, 2024; Revised: March 18, 2024; Accepted: April 01, 2024; Published: May 03, 2024.
*Corresponding author: Dr. Mehdi Keddar, MD, DDS, Department of Stomatology and Maxillofacial Surgery, The Brussels University Hospital (H.U.B),
Université Libre de Bruxelles, Route de Lennik 808, 1070, Brussels, Belgium; Tel. /Fax: +32 (0) 2 555 55 55;
e-mail: mehdi.keddar@hotmail.com
Copyright: © 2022 the Editorial Council for the Stomatology Edu Journal.
ORAL SURGERY
Large Mandibular Lipoma: A Case Report
Mehdi Keddar
1a*
, Edouard Malengrez
1b
, Cynthia Watteeuw
1c
, Laurence Evrard
1d
,
Firas Shall
1e
, Christophe Politis
1f
1
Department of Stomatology and Maxillofacial Surgery, The Brussels University Hospital (H.U.B), Université Libre de Bruxelles 1070-Brussels, Belgium
a
DaMD, DDS; e-mail: mehdi.keddar@hotmail.com; ORCIDiD: https://orcid.org/0009-0005-1715-8968
b
Medical student; e-mail: edouard.malengrez@ulb.be
c
MD, DDS; e-mail: cynthiawatteeuw@gmail.com
d
MD, DDS, PhD, Director; e-mail: laurence.evrard@ulb.be; ORCIDiD: https://orcid.org/0000-0001-5581-4093
e
MD, DDS; e-mail: firasshall@gmail.com; ORCIDiD: https://orcid.org/0000-0003-3061-2625
f
MD, DDS; e-mail: christophe.politis@gmail.com; ORCIDiD: https://orcid.org/0000-0002-1076-1327
ABSTRACT
This case report describes an intraoral lipoma in a 29-year-old female, a rare occurrence given the signicant
size of the lesion, which exceeded the common threshold of 2.5 cm for intraoral lipomas. Typically manifesting
in areas such as the buccal mucosa and tongue, the lipoma in this case was located on the buccal mucosa,
underscoring the variability in presentation sites. Surgical excision, the standard approach for such tumors,
was the chosen treatment, with a successful outcome and no recurrence. This case report adds to the
limited body of literature on intraoral lipomas, highlights the potential for atypical presentations in size, and
emphasizes the eectiveness of surgical management.
https://doi.org/10.25241/stomaeduj.2024.11(1-2).art.8
KEYWORDS
Maxillofacial Surgery; Intraoral Lipoma; Lipoma Management; Oral Pathology; Soft Tissue Tumor.
Figure 1. Preoperative intraoral view.
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Case Report
Intraoral Lipoma
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cervical ultrasound revealed a 37-mm mass in the left
cheek, initially suggestive of a lipoma (Fig. 2).
This diagnosis was later conrmed by an MRI, which
delineated a lesion with fat signal characteristics
(hyperintense in T1 and T2, hypointense in T2 with
fat saturation, and T1 post-gadolinium with fat
saturation), consistent with a lipoma that measured 37
x 13 x 17 mm (length x anteroposterior x craniocaudal).
The lipoma was located along the external aspect of
the left horizontal mandibular branch (Fig. 3).
The decision was made to perform an excisional
biopsy and excision of the lesion (Fig. 4). The
procedure was performed under general anesthesia
due to signicant anxiety on the part of the patient.
An electrocautery unit was used to make an incision
along the vestibular sulcus from tooth 33 to 36, which
immediately exposed the lipoma. Careful dissection
was undertaken to preserve the mandibular nerve,
with meticulous attention to hemostasis. The wound
was then closed with simple interrupted sutures using
3-0 Vicryl (polyglactin 910).
The follow-up after 14 days showed an uneventful
wound healing process; however, there was a transient
hypoesthesia of the mandibular nerve, which resolved
completely after one month.
3. DISCUSSION
This case report regarding an intraoral lipoma in an
adult female patient underscores the clinical rarity
and diagnostic subtleties of these tumors in the oral
cavity. Lipomas, which typically occur in other areas
of the body, manifest distinctively when they occur
in the oral region. This patient's presentation with a
non-tender, soft mass and the subsequent imaging
and histopathological findings are characteristic
of intraoral lipomas and align with reports in the
literature [2]. However, this particular lipoma was
signicantly larger than average, as intraoral lipomas
rarely exceed 2.5 cm in diameter [3].
Regarding the localization of intraoral lipomas, the
buccal mucosa is the most common site, followed by
the tongue; together, these two sites account for 50%
of intraoral lipomas. Other notable locations include
the lip, palate and oor of the mouth, vestibule,
retromolar area, and gingiva [4].
Approximately 5% of lipomas can manifest in multiple
forms and are associated with conditions such as
neurobromatosis or familial adenomatous polyposis
syndrome [4,5]. However, cases of intraoral lipomas
appear to be exclusive and solitary in nature [6].
A notable aspect of this case is the patient's lack of
signicant medical history, with the exception of
tobacco use. Tobacco consumption has not been
conclusively linked to the development of intraoral
lipomas, which suggests that the occurrence of these
tumors could be independent of tobacco use. The
exact cause of lipomas is still not fully understood, and
the occurrence of lipomas appears to be inuenced
by multiple factors with no direct correlation to habits
such as tobacco consumption. Some researchers have
proposed that lipoma formation might be triggered
by recurrent minor trauma that potentially stimulates
the growth of fatty tissue. However, a definitive
link between such trauma and the occurrence of a
lipoma remains elusive. Other studies have suggested
that these tumors may originate from embryonic
multipotential cells, which are dormant until
hormonal changes during adolescence activate their
dierentiation into mature adipose tissue, leading to
the gradual emergence of a lipoma [6].
Diverse subtypes of lipomas have been described.
In the reported case, the histopathological analysis
established a classic lipoma, the most common variant
of intraoral lipomas, accounting for between 45%
and 50% of all intraoral lipomas (Fig. 5). It has been
suggested that oral lipomas are more common in
males, while oral brolipomas are more frequent in
females; however, there is no clear evidence to support
these suggestions [7], [6]. Our patient presented with
a simple lipoma.
Figure 3. MRI scans with A) axial and B) coronal views (T2 fat-saturated),
illustrating a homogenous, high-signal intensity mass on T1-weighted
images characteristic of a lipoma's fat content
Figure 2. Ultrasonographic image depicting a well-defined hypoechoic
mass consistent with a lipoma.
Figure 4. Operative view after superficial excision showing the mass in
situ, B) isolation and exposure of the lipoma, C) post-excision site showing
the surgical bed, and D) sutured closure of the surgical site.
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Case Report
Keddar M, et al.
Surgical excision remains the treatment of choice,
and there is a less than 1% recurrence rate [6].
Steroid injections in the center of the lipoma have
been suggested in the literature as an alternative
treatment to reduce the size of tumors of less than
2.54 cm in diameter. Because they cause local fat
atrophy, these injections have been associated with
few complications [8]. However, the patient described
in this report was not a suitable candidate for this
treatment. The hypoesthesia, which resolved within
a month, is a relatively uncommon but possible
postoperative complication related to the location of
the lesion. Comprehensive radiographical evaluation
is crucial for both the diagnostic process and the
surgical planning.
4. 5 KEY LEARNING POINTS
1. Intraoral lipomas can present beyond typical size
ranges, highlighting the need for clinical awareness in
dierential diagnosis of soft tissue masses, especially
for non-tender, slow-growing lesions.
2. Imaging, particularly ultrasound and MRI, is essential
for the preliminary identication and characterization
of intraoral lipomas.
3. Surgical excision is highly eective for intraoral
lipomas, with minimal recurrence and manageable
postoperative complications.
4. Histological examination is critical to dierentiate
between the subtypes of oral lipomas, guiding
accurate diagnosis and management.
5. The etiology of intraoral lipomas remains uncertain,
underscoring the need for further research into
potential lifestyle and genetic factors.
AUTHOR CONTRIBUTIONS
MK, CW, FS Patient management. MK, EM Drafting of the article. LE
Revision of the article. CP Revision and nal approval of the article.
ACKNOWLEDGMENTS
We extend our deepest gratitude to the patient who consented to
the publication of this case, enabling us to share valuable insights
with the medical community. Our thanks also go to the entire
team at the Stomatology and Maxillofacial Surgery Department
at HU Bruxelles Erasme for their exceptional care and dedication
in managing this case. Special appreciation is directed towards
the radiology department for their expertise and assistance in the
diagnostic process, which was pivotal for the successful treatment
outcome.
Figure 5. Excised lipoma.
REFERENCES
1. Kumaraswamy SV, Madan N, Keerthi R, Shakti S. Lipomas of oral
cavity: case reports with review of literature. J Maxillofac Oral Surg.
2009 Dec;8(4):394-397. doi: 10.1007/s12663-009-0096-6. Epub 2010
Apr 24.
Full text links CrossRef PubMed Google Scholar Scopus WoS
2. Furlong MA, Fanburg-Smith JC, Childers EL. Lipoma of the oral and
maxillofacial region: Site and subclassication of 125 cases. Oral Surg
Oral Med Oral Pathol Oral Radiol Endod. 2004 Oct;98(4):441-450. doi:
10.1016/j.tripleo.2004.02.071.
Full text links CrossRef PubMed Google Scholar WoS
3. Azzouz Y, Abidi S, Zidane FZ, Chbicheb S. An unusual intraoral
lipoma: case report and review of the literature. Pan Afr Med J. 2022
Apr 26;41:336. doi: 10.11604/pamj.2022.41.336.34808.
Full text links PubMed Google Scholar
4. Egido-Moreno S, Lozano-Porras AB, Mishra S, et al. Intraoral
lipomas: Review of literature and report of two clinical cases. J Clin
Exp Dent. 2016 Dec 1;8(5):e597-e603. doi: 10.4317/jced.52926.
Full text links CrossRef PubMed Google Scholar
5. de Visscher JG. Lipomas and brolipomas of the oral cavity.
J Maxillofac Surg. 1982 Jan 1;10:177-181. doi:10.1016/S0301-
0503(82)80036-2
CrossRef PubMed Google Scholar WoS
6. Fregnani ER, Pires FR, Falzoni R, Lopes MA, Vargas PA. Lipomas
of the oral cavity: clinical ndings, histological classication and
proliferative activity of 46 cases. Int J Oral Maxillofac Surg. 2003 Feb
1;32(1):49-53. doi:10.1054/ijom.2002.0317
Full text links CrossRef PubMed Google Scholar WoS
7. Salam GA. Lipoma excision. Am Fam Physician. 2002 Mar
1;65(5):901-905. PMID: 11898962.
Full text links CrossRef PubMed Google Scholar
CV
Dr. Mehdi Keddar was a doctoral student at the Université Catholique de Louvain (2011-2019) where he obtained his MD title
(Doctor of Medicine). He obtained hid DDS title (Doctor of Dental Surgery) after a three-year period of studies (2019-2022) at
the Université Libre de Bruxelles. Since 2019 he has been a Resident in Training at the Université Libre de Bruxelles (Stomatology
and Maxillo-Facial Residency).
Mehdi KEDDAR
MD, DDS
Department of Stomatology and Maxillofacial Surgery
The Brussels University Hospital (H.U.B)
Université Libre de Bruxelles
1070, Brussels, Belgium
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Questions
1. What is the most common location for intraoral lipomas?
qa. Palate;
qb. Buccal mucosa;
qc. Tongue;
qd. Floor of the mouth.
2. Which imaging technique is NOT typically used for the diagnosis of intraoral lipomas?
qa. Ultrasound;
qb. MRI;
qc. CT Scan;
qd. PET Scan.
3. What is the age range most commonly associated with the occurrence of intraoral
lipomas?
qa. 20-30 years;
qb. 40-60 years;
qc. 10-20 years;
qd. 30-40 years.
4. Which of the following is NOT a subtype of oral lipomas mentioned in the report?
qa. Simple lipomas;
qb. Fibrolipomas;
qc. Spindle cell lipomas;
qd. Osteolipomas.
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