A rare case of oral cavity lipoma in the inferior vestibule: a case report and literature review

Abstract

Abstract Background Lipomas are ubiquitous tumors. They are mostly present in the trunk as well as the proximal portion of the limbs. However, 15–20% are located in the head and neck regions, and only 4.4% are found in the oral cavity. They normally present as a bulge with signs of compression, without signs of infiltration. Case presentation This is the rare case of a 36-year-old man, who was admitted to ENT consultation for a bulge in the left inferior vestibule of the oral cavity. The bulging was not painful, with no inflammatory signs, no dental mobility, or abnormalities in the vestibular mucosa. No other masses were found in the general clinical exam. The patient underwent a dental panoramic X-ray, which showed a low opacity lesion next to the left inferior vestibular space, without signs of bone invasion. There was no hypoesthesia in the territory of the alveolar nerve was found. The patient underwent a craniofacial MRI which showed a mass which was hypointense on T1 and hyperintense on T2. Fine needle aspiration was not performed. The patient’s pre-operative blood work showed no abnormalities. He underwent surgical excision under general anesthesia. The incision was carried out in the left inferior vestibular space, 1 cm away from the alveolar gingiva; careful dissection of the mucosa allowed the discovery of a large fatty mass, encapsulated, with a nourishing pedicle, without signs of invasion or ulceration in the adjacent structures. Careful dissection and hemostasis were performed, followed with the closure of the mucosa with Vicryl 4.0. The histopathological exam showed mature adipose tissue. The fat contains few small capillaries within thin fibrous strands. A thin fibrous capsule was seen. Clinical follow-up of 2 months showed no complications. The surgical incision healed perfectly, and no bulging was noticed upon palpation. Conclusions This is the rare case of a vestibular lipoma of the oral cavity; the clinical and radiological aspect allowed consideration of several differential diagnoses. The most important take away lesson is related to the very rich variety of differential diagnosis in oral cavity masses. Clinical and radiological aspects allow the clinician to have diagnostic theories. Only histological results allow to establish a definitive diagnosis.