Huge Lipoma in the Floor of the Mouth: A Case Report

Lipomas are adipose mesenchymal neoplasms. The oral cavity is not commonly affected. representing about0.5% to 5% of all benign oral tumors. The clinical presentation is typically as an asymptomatic yellowish mass.The overlying epithelium is intact and superficial blood vessels are usually evident over the tumour. Although benign in nature their progressive growth may cause interference with speech and mastication due to tumour’s dimension. The present report shows the case of a 52-year old male who presented with a large intraoral lipoma with extension to the right submandibular region.


Introduction
all the others were angiolipomas, intramuscular lipomas, or lipoblastomas 6. Most of lipomas develop in the subcutaneous tissues but deeper tissues may be involved as well the oral cavity is not commonly affected 7 . Oral lipomas can occur in various anatomic sites including the major salivary glands, buccal mucosa, lip, tongue, palate, vestibule and floor of mouth. 8,9 The present report shows the case of a 52-year old male who presented with a large intraoral lipoma with extension to the submandibular region.

Case Report
A 52 years old otherwise healthy man was presented with a huge swelling in the right side of the floor of the mouth. The swelling increased gradually and extended to the right submandibular region for last one year. The swelling was painless and slow growing. It gradually impaired the movement of the tongue speech and deglutition. It crossed the midline and extended from whole anterior part of floor of mouth to right lower last molar tooth. In the neck the swelling occupied right submental and submandibular region.
Excision of the mass was done per-orally under general anaesthesia in National Hospital Pvt. Ltd. in Mehedibag, Chittagong. An incision was given in the right side of the floor of the mouth. The mass was dissected carefully. After that muscles of the floor of the mouth were splitted out and retracted. Then the mass in the neck dissected carefully. Then the whole mass was removed per orally.
Macroscopically the mass was yellowish, soft, well demarcated and bilobbed measuring 9.1cm ×4cm×3cm. One lobe was above and the other lobe was below the muscles of the floor of the mouth.A pressure bandage was given in the right side of the neck to prevent collection in the neck space. Oral incision was closed keeping a small drain orally which was removed after 24 hours.
Post operatively the functions of the tongue and salivary glands were normal. Histopathological examination of the mass revealed lipoma.
On both oral and neck palpation it was non tender, soft, fluctuant, compressible and mobile. No neck node was found palpable. Systemic examinations revealed no abnormities. Patient was non diabetic, non hypertensive, non asthmatic and no other comorbidity.
USG revealed a soft tissue mass in the floor of the mouth extended to the right submandibular region. FNAC report was lipoma. Routine tests were normal.

Discussion
Lipomas develop mostly in the subcutaneous tissues and only rarely in deep tissues. They most commonly involve the trunk and limbs of the body and seldom the oral and maxillofacial region 10,11 .The female to male ratio for all lipoma is 2: l but oral lipoma occur more in men than in women (1.5: 1) 12 . Lipoma usually develop in patients over 40. The buccal mucosa and vestibule are the most commonly involved in intraoral sites. They present as slow growing asymptomatic lesions with yellowish in colour, soft, doughy feel, generally with no gender predilection. 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 [13][14][15] . The microscopic appearance is circumscribed but not encapsulated aggregate of mature adipocytes with large clear cytoplasm and absence of vascularity is diagnostic of a classical lipoma 14 . Ultrasonography is quick, easy, less costly and with the use of highfrequency transducers it is really suitable for evaluation of superficial structures especially when difficulties exist in identifying the mass from adjacent tissues as it happens in the oral and maxillofacial region. The clinical differential diagnosis includes ranula, dermoid cyst, thyroglossal duct cyst, ectopic thyroid tissue, pleomorphic adenoma, mucoepidermoid carcinoma, angiolipoma, fibrolipoma and malignant lymphoma [16][17][18] .

Conclusion
The above case demonstrates the heterogenicity regarding the presentation of the lipoma at a very unusual site, i.e., the floor of the mouth and its remarkable large size. Clinicians and pathologists should keep in mind this unusual presentation of lipoma as a differential diagnosis in a similar case of suspected soft tissue neoplasm to prevent further morbidity of the disease for want of accurate diagnosis. Meticulous clinico pathological evaluation can hit the surprising diagnosis and prevent the untoward complications of treatment modalities.