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British Journal of Oral and Maxillofacial Surgery 48 (2010) 203204

Short communication

Lipoma of the parotid gland extending from the supercial to the deep lobe: a rarity
Subhas Chandra Debnath a, , Antara Saikia b
a b

Department of Oral & Maxillofacial Surgery, Regional Dental College, Indrapur, 781032 Guwahati, India North Guwahati Primary Health Centre, Guwahati, India

Accepted 28 July 2009

Abstract Lipoma of the parotid gland is a rare clinical entity. Because of the rarity, they are not often considered in the differential diagnosis of parotid tumors. Lipoma of the parotid gland constitutes around 3% of all parotid tumors. These are asymptomatic and occur both in the deep and the supercial lobe of the parotid.1 The most favored age group is from the fth to sixth decade of life and is 10 times more common in the males.6 Lipoma extending from supercial to deep lobe of parotid gland has not been reported in the literature to our knowledge till date. A 56-year-old male patient, with this relatively rare parotid gland lipoma is reported in this article; it was managed by conservative supercial parotidectomy preserving facial nerve that, if performed correctly, excludes the possibility of any second attack. 2009 The British Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.
Keywords: Lipoma; Parotid gland; Deep lobe

Introduction A lipoma is a common benign tumor of mesenchymal origin that can arise everywhere where fat is normally present. Over 10% develop in the head and neck region. Rarely they can arise in the oral cavity, pharynx, larynx, and parotid gland.1 Their incidence among parotid tumors ranges from 0.6% to 4.4%, with most series reporting an incidence of 1%.2 About 140 cases of lipoma of the parotid gland have been reported. We entered the key words parotid, benign tumors, and lipoma into web sites and found 31 individual case reports over a period of two decades, of which there were only two case reports from India,3,4 and one from Pakistan.5 Because of the relative rarity of lipomas in the parotid region, we present

what we think is a unique case of intraglandular lipoma that clinically resembled a salivary gland neoplasm of the parotid gland. Case report A 56-year-old man presented with a right facial mass and requested excision to improve his facial appearance. He had been aware of a slow growing, painless swelling for three years, and clinical examination conrmed a mobile, soft, nontender, intraglandular mass that measured 5 6 cm. Function of the facial nerve was intact. The most likely diagnosis was lipoma or mixed tumor of the parotid gland. T1- and T2-weighted axial magnetic resonance images (MRIs) showed a well-dened lesion in the supercial lobe of the right parotid gland. This was bright on both T1- and T2-weighted sequences. The lesion extended from the supercial to the deep lobe through the stylomandibular notch.

Corresponding author at: Sai Dental Clinic & Facio-Maxillary Surgery Centre, Rajgarh Road, Bhangagarh, Opposite to Alcare Diagnostic Centre, House no. 148, 781005 Guwahati, Assam, India. Tel.: +91 098642 95743. E-mail address: drsubhas@rediffmail.com (S.C. Debnath).

0266-4356/$ see front matter 2009 The British Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.

doi:10.1016/j.bjoms.2009.07.028

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S.C. Debnath, A. Saikia / British Journal of Oral and Maxillofacial Surgery 48 (2010) 203204

We did a supercial parotidectomy under general anaesthesia using a classic Blairs incision. The distal portion of the tumor extended deep to the plane of the facial nerve, above the two main divisions, and could be removed while preserving the facial nerve and the deep portion of the parotid gland The gross specimen was a well circumscribed, soft, and yellowish mass measuring 7 5 3 cm with brofatty tissue surrounding it. Histological sections showed lobules of adipose tissue separated by a thin core of connective tissue stroma. Features were consistent with that of a lipoma. The patient has been followed-up for 15 months and there has been nothing to suggest a recurrence. Discussion Lipomas are the most commonly encountered benign mesenchymal tumors and are histologically similar to mature adipose tissue. MRI can accurately diagnose lipomas preoperatively by comparing the signal intensity on T1- and T2-weighted images.2,6 The margin of a lipoma is clearly dened by MRI as a black-rim, enabling them to be distinguished from surrounding adipose tissue, a distinction that cannot be made from CT.7 During operation most surgeons recommend supercial parotidectomy with dissection of the facial nerve before removal of lesions in the deep lobe.8 In our experience we exposed all the branches from the main trunk of the facial nerve by meticulous dissection and supercial parotidectomy. Lipomas that involve the deep parotid lobe are extremely rare, and their management is challenging; it should include meticulous dissection of the branches of the facial nerve. The postoperative aesthetic and functional results should be the major concerns (Figs. 13). References
1. Som PM, Scherl MP, Rao VM, Biller HF. Rare presentations of ordinary lipomas of the head and neck: a review. Am J Neuroradiol 1986;7:65764. 2. Korentager R, Noyek AM, Chapnik JS, Steinhardt M, Luk SC, Cooter N. Lipoma and liposarcoma of the parotid gland: high resolution preoperative imaging diagnosis. Laryngoscope 1988;98:96771. 3. Chidananda KV, Sivamani S, Viswakumar V, Nayak KG, Sai Geetha KK, Vinayaka P. Intraglandular lipoma of the parotid gland. Indian J Surg 2007;69:6870. 4. Nanavati SD. Lipoma of the parotid gland. A case report. J Indian Dent Assoc 1983;55:4413. 5. Muzaffar S, Kavani N, Hasan SH. Parotid gland lipomaa rare entity. J Pak Med Assoc 1996;46:2623. 6. Chikui T, Yonetsu K, Yoshiura K, et al. Imaging ndings of lipomas in the orofacial region with CT, US, and MRI. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 1997;84:8895. 7. Srinivasan V, Ganesan S, Premachandra DJ. Lipoma of the parotid gland presenting with facial palsy. J Laryngol Otol 1996;110:935. 8. Weiner GM, Pahor AL. Deep lobe parotid lipoma: a case report. J Laryngol Otol 1995;109:7723.

Fig. 1. T2-weighted axial images showing a well-dened lesion in the supercial lobe of the right parotid gland. The lesion is bright on both T1- and T2-weighted sequences, and extends from the supercial to the deep lobe through the stylomandibular notch.

Fig. 2. Lipoma on the deep parotid lobe above the temporofacial trunk of the facial nerve.

Fig. 3. Photograph taken after removal of the lipomatous mass, having preserved the facial nerve.