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 Table of Contents  
CASE REPORT
Year : 2019  |  Volume : 11  |  Issue : 2  |  Page : 85-88

Surgical excision of intraoral lipoma on buccal mucosa


Department of Periodontology and Implantology, MGVs KBH Dental College and Hospital, Nashik, Maharashtra, India

Date of Submission03-Mar-2019
Date of Acceptance29-May-2019
Date of Web Publication15-Jul-2019

Correspondence Address:
Shreeprasad Vijay Wagle
Department of Periodontology and Implantology, MGVs KBH Dental College and Hospital, Nashik, Maharashtra
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jorr.jorr_10_19

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  Abstract 


Lipomas are found rarely in the oral cavity. These tumors are of mesenchymal origin in the human body. Their etiology is still not clear. There are different theories to explain the pathogenesis of this adipose tissue tumor. Lipoma has different histological variants given in the literature. A case of intraoral lipoma occurring on the buccal mucosa in a 42-year-old male patient is reported in this article. Surgical excision was performed, and 1-month follow-up showed excellent healing without any recurrence. Lipomas are benign soft-tissue neoplasm of mature adipose tissue seen as a common entity in the head-and-neck region. Intraoral lipomas are rare tumors that may be noticed only during routine dental examinations. Rarely, they cause pain, resulting in delay to get the treatment done.

Keywords: Adipose tissue, intraoral lipoma, surgical excision


How to cite this article:
Wagle SV, Agrawal AA, Sankhe R, Bardoliwala D. Surgical excision of intraoral lipoma on buccal mucosa. J Oral Res Rev 2019;11:85-8

How to cite this URL:
Wagle SV, Agrawal AA, Sankhe R, Bardoliwala D. Surgical excision of intraoral lipoma on buccal mucosa. J Oral Res Rev [serial online] 2019 [cited 2019 Aug 25];11:85-8. Available from: http://www.jorr.org/text.asp?2019/11/2/85/262758




  Introduction Top


Lipoma is the benign tumor that consists of mature adipocytes, and it can be seen anywhere in the human body where adipocytes are present. They account for 15%–20% of all benign tumors and 4%–5% of benign tumors in the head-and-neck region.[1],[2] Intraoral lipomas are rare and comprise only 0.1%–5% of all benign tumors in the intraoral cavity.[3] Intraorally, lipoma is seen as long-standing soft nodular asymptomatic swellings covered by normal mucosa. Histologically, lipoma can be classified as simple lipoma, fibrolipoma, spindle cell lipoma, intramuscular or infiltrating lipoma, angiolipoma, pleomorphic lipoma, myxoid lipoma, and atypical lipoma. Intramuscular or infiltrating adipose tumor is an uncommon mesenchymal neoplasm, usually appearing in the extremities or trunk but rarely occurring in the oral cavity.[4] Oral infiltrating lipomas are larger than the ordinary oral lipomas and present clinically as deep-seated, slow growing, painless masses.[5] Even if lipomas can occur anywhere in the intraoral cavity, the major salivary glands (especially the parotid gland) are most frequently affected, followed by the buccal mucosa, lip, tongue, palate, floor of the mouth, and gingiva.[6] Lipoma in the oral cavity can cause discomfort, difficulty in chewing, dysphagia, and dyspnea. They are nontender. Lipoma generally has well-defined margins, so surgical excision is recommended in such case.[7] If they occur in the parotid gland, however, conservative treatment is preferred to preserve the facial nerve.[8] Herein, we review the literature and report a case of intraoral lipoma on the right buccal mucosa treated by surgical excision.


  Case Report Top


A 42-year-old male patient residing at Nashik reported to the Department of Periodontology and Implantology with the chief complaint of swelling on the lower right cheek region for a year. Swelling was gradually increasing in size as noticed by the patient. The patient also complained of discomfort in chewing the food as that growth interferes while biting. The patient did not have any relevant medical history and family history. There were no such lesions in the body other than the oral cavity. Extraoral examination revealed normal facial symmetry and no abnormality in temporomandibular joints and his report suggested that submandibular lymph nodes were clinically not palpable. Intraoral examination showed oval growth of about 8 mm × 7 mm on the buccal mucosa in relation to 45–46 region [Figure 1]. It was movable, pedunculated, soft in consistency, and nontender. It is pale pink and covered with normal mucosa without ulceration or inflammation. We did not find any other growth in the oral cavity.
Figure 1: (a) Intraoral examination showed oval growth of about (b) 8 mm × 7mm on buccal mucosa in relation to 45–46 region. (c) Excision was done using electrocautery. (d) Excised tissue

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Under aseptic conditions, excisional biopsy was done under local anesthesia using electrocautery. 3.0 silk sutures were given [Figure 1] and [Figure 2]. Tissue was excised and stored in 10% formalin for further histopathological investigations. Recall appointment on the 7th day showed satisfactory healing, and thus sutures were removed [Figure 3].
Figure 2: (a) Wound site and (b) after suturing with 3.0 silk sutures

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Figure 3: Clinical picture of healing at excision site after (a) 7 days and (b) 1 month, respectively

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In the histopathological examination, H and E staining showed tissue composed of closely packed oval cells with a flat nucleus and clear cytoplasm suggestive of adipocytes [Figure 4]. The cells were separated by fibrous strands containing few blood vessels surrounded by fibrous capsule. At places, deeper part shows transversally and longitudinally cut muscle fibers. The overlying epithelium is parakeratinized stratified squamous epithelium. Histopathological features [Figure 5] are suggestive of fibrolipoma. Follow-up after 1 and 3 months showed completely healed excision site without any inflammatory signs. The patient was comfortable.
Figure 4: Histopathological examination H and E staining showed adipocytes. (a) At × 10 and (b) ×40 zoom, respectively (marked with arrow)

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Figure 5: Clinical picture of healing at excision site after 3 months

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  Discussion Top


Lipomas are benign soft-tissue tumor of mature adipose tissue seen as a typical entity within the head-and-neck region. Intraoral lipomas are rare, the statistics showing just one to four affecting these sites.[3],[9] Furlong et al. found only 125 cases of oral lipomas over 20 years, which again shows the rarity of this oral tumors.[10] The first description of an oral lesion was provided by Rajendran in 1848, in a review of alveolar masses which he referred to as “yellow epulis.”[11]

The etiology of intraoral lipoma remains unclear, but the suggested pathogenic mechanisms include the “hypertrophy theory,” which states that obesity and inadvertent growth of adipose tissue may contribute to the formation of these oral lesions. However, this theory fails to convince those lesions which occur in area with empty preexisting fatty tissue.[12] They are not used up in general metabolism during periods of starvation like normal adipose tissue. Another theory referred to as “metaplasia theory” suggests that lipomatous development happens because of aberrant differentiation of in situ mesenchymal cells into lipoblast since fatty tissue can be derived from mutable connective tissue cells almost anywhere in the body.[13] Lin and Lin recommended that these benign entities are inherent lesions arising from embryonic multipotential cells that stay subclinically dormant till they differentiate into fat cells beneath hormonal influence throughout adolescence.[14] However, in some cases, trauma and chronic irritation may trigger the proliferation of soft tissue and play a role in the development of a lipoma.[1]

A review of 26 cases done by de Freitas et al. in the Brazilian population showed that the mean age of incidence is 54.6 years.[15] Fornage and Tassin reported that the peak incidence occurs in the fifth or sixth decades of life;[16] whereas rare cases of congenital lipomas have been reported in 20- and 47-day-old babies. This benign tumor occurs predominantly in females,[3] while literature showing equal sex distribution with a male-to-female ratio of 1:1.2 has also been reported.[17]

Lipomas are reported in different parts of the body that includes the regions of back, shoulder, neck, and extremities.[15] Intraoral counterparts are rare; the most common site of oral lipomas is the oral mucosa, a region rich in fatty tissue, followed by the tongue, lips, floor of the mouth, palate, and gingival. This pattern corresponds to the amount of fat deposits within the mouth.[18],[19] Rare cases of intraosseous lipomas have been described by Oringer in the body of mandible and ramus, respectively.[20],[21]

The differential diagnosis of intraoral lipoma includes oral dermoid and epidermoid cysts, fibroma, oral lymphoepithelial cyst, benign salivary gland tumor, mucocele, benign mesenchymal neoplasm, ranula, ectopic thyroid tissue, and lymphoma. The diagnosis of intraoral lipomas is usually clinical. Computed tomography and magnetic resonance imaging help the diagnosing of those tumors to be created quite without delay. In spite of the availability of all these techniques, histopathology remains the gold standard in the diagnosis of lipoma.[5] Histologically, the tumor is composed of adult fat cells that are subdivided into lobules by fibrous connective tissue septa. Based on microscopical features, they are classified into classic lipoma, fibrolipoma, angiolipoma, spindle cell lipoma, and pleomorphic, myxoid, sialolipoma, and intramuscular lipomas.[1] Among these variants, myxoid lipomas and angiolipomas are rarely found in the oral cavity.[17] Diversity in histological pattern such as dense fibrous connective tissue septa, spindle cell components, mitotically active atypical cells, mature blood vessels, myxoid stroma, or even salivary acinar structures is seen along with mature adipose tissue depending on each variant.[1] Lipoma of the oral cavity is treated by conservative local excision, and the local recurrence is extremely rare.[1],[18],[22]

Treatment for intraoral lipoma is complete surgical excision. No recurrence has been described after local excision. The diode laser can be used as a modality for oral soft-tissue surgery. Excision with laser would reduce bleeding and also lower swelling and scarring of the surgical site, comparing to the simple surgeries.[23] Medical management of lipomas, which is now common, includes steroid injections that result in local fat atrophy, thus, shrinking the tumor size. They are best done on lipomas that are <1” in diameter.


  Conclusion Top


Intraoral lipomas are a rare entity which may be detected solely after routine dental examinations. Most of them seldom cause pain, resulting in delay to seek treatment. The patient's issues could also be relating to esthetics or discomfort. Newer medical procedure treatment modalities are still under trial, which can be applied in the recent future.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Acknowledgment

I thank department of Oral pathology, MGVs KBH dental college and hospital for their constant support.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Fregnani ER, Pires FR, Falzoni R, Lopes MA, Vargas PA. Lipomas of the oral cavity: Clinical findings, histological classification and proliferative activity of 46 cases. Int J Oral Maxillofac Surg 2003;32:49-53.  Back to cited text no. 1
    
2.
Guillou L, Dehon A, Charlin B, Madarnas P. Pleomorphic lipoma of the tongue: Case report and literature review. J Otolaryngol 1986;15:313-6.  Back to cited text no. 2
    
3.
de Visscher JG. Lipomas and fibrolipomas of the oral cavity. J Maxillofac Surg 1982;10:177-81.  Back to cited text no. 3
    
4.
Ayasaka N, Chino T Jr., Chino T, Antoh M, Kawakami T. Infiltrating lipoma of the mental region: Report of a case. Br J Oral Maxillofac Surg 1993;31:388-90.  Back to cited text no. 4
    
5.
Epivatianos A, Markopoulos AK, Papanayotou P. Benign tumors of adipose tissue of the oral cavity: A clinicopathologic study of 13 cases. J Oral Maxillofac Surg 2000;58:1113-7.  Back to cited text no. 5
    
6.
Pass B, Guttenberg S, Childers EL, Emery RW. Soft tissue lipoma with the radiographic appearance of a neoplasm within the mandibular canal. Dentomaxillofac Radiol 2006;35:299-302.  Back to cited text no. 6
    
7.
Han CH, Kook MS, Park HJ, Oh HK, Ryu SY, Cho JH. Infiltrating lipoma of the cervical and parotid area: Report of a case. J Korean Assoc Oral Maxillofac Surg 2006;32:598-602.  Back to cited text no. 7
    
8.
Debnath SC, Saikia A. Lipoma of the parotid gland extending from the superficial to the deep lobe: A rarity. Br J Oral Maxillofac Surg 2010;48:203-4.  Back to cited text no. 8
    
9.
Hatziotis JC. Lipoma of the oral cavity. Oral Surg Oral Med Oral Pathol 1971;31:511-24.  Back to cited text no. 9
    
10.
Furlong MA, Fanburg-Smith JC, Childers EL. Lipoma of the oral and maxillofacial region: Site and subclassification of 125 cases. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2004;98:441-50.  Back to cited text no. 10
    
11.
Rajendran R. Shafer's Textbook of Oral Pathology. India: Elsevier; 2009.  Back to cited text no. 11
    
12.
Gupta TK. Tumors and tumor-like conditions of the adipose tissue. Current Problems in Surgery 1970;7:3-60.  Back to cited text no. 12
    
13.
Ashley DJB. Evans' histological appearances of tumours Vol. 2. Churchill Livingstone; 1978.  Back to cited text no. 13
    
14.
Lin JJ, Lin F. Two entities in angiolipoma. A study of 459 cases of lipoma with review of literature on infiltrating angiolipoma. Cancer 1974;34:720-7.  Back to cited text no. 14
    
15.
de Freitas MA, Freitas VS, de Lima AA, Pereira FB Jr., dos Santos JN. Intraoral lipomas: A study of 26 cases in a Brazilian population. Quintessence Int 2009;40:79-85.  Back to cited text no. 15
    
16.
Fornage BD, Tassin GB. Sonographic appearances of superficial soft tissue lipomas. J Clin Ultrasound 1991;19:215-20.  Back to cited text no. 16
    
17.
Dimitrakopoulos I, Zouloumis L, Trigonidis G. Congenital lipoma of the tongue. Report of a case. Int J Oral Maxillofac Surg 1990;19:208.  Back to cited text no. 17
    
18.
Studart-Soares EC, Costa FW, Sousa FB, Alves AP, Osterne RL. Oral lipomas in a Brazilian population: A 10-year study and analysis of 450 cases reported in the literature. Med Oral Patol Oral Cir Bucal 2010;15:e691-6.  Back to cited text no. 18
    
19.
Lucas RB. Pathology of Tumours of the Oral Tissues. Churchill Livingstone; 1984.  Back to cited text no. 19
    
20.
Oringer MJ. Lipoma of the mandible. Oral Surg Oral Med Oral Pathol 1948;1:1134.  Back to cited text no. 20
    
21.
Johnson EC. Intraosseous lipoma: Report of case. J Oral Surg 1969;27:868-70.  Back to cited text no. 21
    
22.
Juliasse LE, Nonaka CF, Pinto LP, Freitas Rde A, Miguel MC. Lipomas of the oral cavity: Clinical and histopathologic study of 41 cases in a Brazilian population. Eur Arch Otorhinolaryngol 2010;267:459-65.  Back to cited text no. 22
    
23.
Taheri JB, Mansouri Z, Babaee S, Azimi S. Intraoral lipoma: Report of two cases with diode laser excision. J Dent Lasers 2014;8:26.  Back to cited text no. 23
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    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5]



 

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