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CASE REPORT
Year : 2014  |  Volume : 8  |  Issue : 1  |  Page : 26-28

Intraoral lipoma: Report of two cases with diode laser excision


Department of Oral medicine and Diagnosis, Dental School, Shahid Beheshti University of Medical Sciences, Tehran, Iran

Date of Web Publication9-Jun-2014

Correspondence Address:
Somayyeh Azimi
Department of Oral Medicine, Dental School, Shahid Beheshti University of Medical Sciences, Tehran
Iran
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0976-2868.134120

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  Abstract 

Lipoma, a benign tumor of adipose tissue is one of the most common benign neoplasms of the body. However, its occurrence in oral cavity is very rare. It accounts for 1-4% of benign neoplasms of mouth affecting predominantly the buccal mucosa, floor of mouth and tongue. We report two cases of intraoral lipoma both of them in buccal vestibule. An excisional biopsy with diode laser was performed and histopathology examination revealed proliferation of mature adipocytes arranged in lobules and separated by fibrous septa in the first case, and the second case was a fibrolipoma.

Keywords: Diode laser surgery, lipoma, oral


How to cite this article:
Taheri JB, Mansouri Z, Babaee S, Azimi S. Intraoral lipoma: Report of two cases with diode laser excision. J Dent Lasers 2014;8:26-8

How to cite this URL:
Taheri JB, Mansouri Z, Babaee S, Azimi S. Intraoral lipoma: Report of two cases with diode laser excision. J Dent Lasers [serial online] 2014 [cited 2017 May 26];8:26-8. Available from: http://www.jdentlasers.org/text.asp?2014/8/1/26/134120


  Introduction Top


Lipoma is the most common soft tissue mesenchymal neoplasms, with 15-20% of cases involving the head and neck region and only 1-4% affecting the oral cavity, [1] they are not common in the oral cavity. [2],[3] Oral cavity lipomas usually present as slow-growing, painless, and asymptomatic tumors. It is known that with continued growth, their size may interfere with speech and mastication. [2],[4] The most prevalent site for intraoral lipoma is buccal mucosa and buccal vestibule. Oral and maxillofacial lipomas, involve both sexes equally, although one study has mentioned a notable male predilection. Lipomas are mostly in people older than 40 years and are not common in children. [5] The tumors are either encapsulated or nonencapsulated or present in an infiltrating manner. [1]


  Case Reports Top


Case 1

A 59-year-old male patient was referred to Oral Medicine Department of Shahid Beheshti Dental School. He had a large tumor at the left posterior oral buccal mucosa [Figure 1] that he had been aware of for 2 years by his dentist. He had no complaint of the large size of the tumor and felt no interfering with his speech or mastication. He had no teeth at that area.
Figure 1: Intraoral lipoma, Case 1

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With a provisional diagnosis of oral lipoma under local anesthesia, surgical excision of the lesion with diode laser with 300 μm-fiber tip, 810 nm wavelength and 3 W power for 3 × 60s was performed [Figure 2].
Figure 2: After laser excision, Case 1

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A completely pedunculated, yellow, well-circumscribed soft tissue mass with 10 mm diameter was excised and submitted for microscopic examination in 10% buffered formalin. The patient was followed after 1 week and a good healing was observed.

In Histopathologic examination of H and E stained slides, using light microscope (Olympus, Japan), a well-circumscribed nodular mass was seen. A distinct lobular pattern composed of mature adipocytes; cells with large clear cytoplasm and a flat dark nucleus on periphery were seen. Thin septa of fibrous tissue were seen between the closely packed normal looking fat cells. At the borders, a thin fibrous capsule surrounded lesion. According to histopathology features, a definitive diagnosis of lipoma was made.

Case 2

A 39-year-old male was referred to the Department of Oral Medicine of Shahid Beheshti Dental Faculty for a painless swelling in the right buccal vestibule of mandible near the premolars and first molar. Patient first noticed the swelling 6 years back, which was small in size and slowly increased to the present size. At clinical intra oral examination, there was a soft swelling 3 × 3 cm in diameter noted on the right buccal vestibule of mandible. The lesion was well-circumscribed, pedunculated and had normal mucosal color [Figure 3]. On palpation, it was nontender, soft in consistency and had a smooth and intact surface. Surgical excision of the lesion with diode laser with 300 μm-fiber tip, 810 nm wavelength and 3 W power for 3 × 60s was performed for this case also.
Figure 3: Intraoral view of Case 2

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Histopathologic features

Sections show a nodular mass covered by parakeratinized stratified squamous epithelium. The underlying connective tissue composed of mature fat cells with lobular arrangement intermixed with significant fibrous component. Blood vessels are also seen. This microscopic description was compatible with fibrolipoma [Figure 4].
Figure 4: Histopathology image

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  Discussion Top


Lipoma of the oral cavity are rare. [6] Oral cavity lipomas usually present as slow-growing, painless, and asymptomatic tumors. It is known that with continued growth, their size may interfere with speech and mastication. [2],[4] However, our first patient had been aware of for 2 years by his dentist and he had no complaint of the large size of the tumor and felt no interfering with his speech or mastication, maybe because he had no teeth at that area.

The buccal mucosa and buccal vestibule are the most common site for oral lipoma. [5] Our two cases were located at buccal vestibule.

Lipoma have shown equal predilection for involvement of men and women, although one study has reported a marked male predilection [5] both of our patient were male.

Lipoma occur most in patient older than 40 years. [5] Our patients also showed the age beyond 40 years.

Other connective tissue lesions such as granular cell tumor, neurofibroma, traumatic fibroma, and salivary gland lesions (mucocele and mixed tumor) might be included in the differential diagnosis. [7] Furlong et al., studied 125 cases of head and neck lipoma at year 2004, and showed that the average duration for these tumors was 3.2 years. [8] First patient had not noticed the lesion until 2 years ago when his dentist, made him aware. The second patient mentioned that he had the lesion from 6 years ago.

The treatment of oral lipoma, is surgical excision and no recurrence has been observed. [1] 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. The diode laser can be applied for excision of oral soft tissue. [9] In our cases, we used diode laser to cut the base of the lesion. The patient could experience a surgery with complete comfort and without bleeding. After 2 days, the healing occurred, and after 1 week the site of surgery had a very good appearance.

 
  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.Dattilo DJ, Ige JT, Nwana EJ. Intraoral lipoma of the tongue and submandibular space: Report of a case. J Oral Maxillofac Surg 1996;54:915-7.  Back to cited text no. 2
    
3.Del Castillo Pardo de Vera JL, Cebrián Carretero JL, Gómez García E. Chronic lingual ulceration caused by lipoma of the oral cavity. Case report. Med Oral 2004;9:166-7, 163-6.  Back to cited text no. 3
    
4.Keskin G, Ustundag E, Ercin C. Multiple infiltrating lipomas of the tongue. J Laryngol Otol 2002;116:395-7.  Back to cited text no. 4
    
5.Neville B, Damm D, Allen C, Bouquot J. Dermatologic diseases. Oral and Maxillofacial Pathology. Vol. 2. Elsevier Health Sciences; 2009. p. 523-4.  Back to cited text no. 5
    
6.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. 6
    
7.Hoseini AT, Razavi SM, Khabazian A. Lipoma in oral mucosa: Two case reports. Dent Res J (Isfahan) 2010;7:41-3.  Back to cited text no. 7
    
8.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. 8
    
9.Azma E, Safavi N. Diode laser application in soft tissue oral surgery. J Lasers Med Sci 2013;4:206-11.  Back to cited text no. 9
    


    Figures

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



 

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