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Dentomaxillofacial Radiology (2006) 35, 299302

q 2006 The British Institute of Radiology


http://dmfr.birjournals.org

CASE REPORT
Soft tissue lipoma with the radiographic appearance
of a neoplasm within the mandibular canal
B Pass*,1, S Guttenberg2, ELB Childers1 and RW Emery2
1
Department of Diagnostic Services, College of Dentistry, Howard University, Washington, DC, USA; 2Private practice and Department
of Oral and Maxillofacial Surgery, Washington Hospital Center, Washington, DC, USA

Lipomas and lipoma variants are common soft tissue tumours but are not commonly found in the
oral and maxillofacial region. We report a case of a classic lipoma located on the medial aspect of
the mandibular ramus, but not within bone, first seen by an oral and maxillofacial surgeon during
treatment planning for routine extractions. Initial panoramic radiography indicated an expansive
tumour in the area of the mandibular foramen and proximal end of the mandibular canal, apparently
within the body of the mandible. Subsequent imaging with CT revealed a well-circumscribed soft
tissue tumour on the medial aspect of the left mandibular ramus, not within the bone itself.
Histological analysis of the operative specimen indicated a classic lipoma.
Dentomaxillofacial Radiology (2006) 35, 299302. doi: 10.1259/dmfr/52088107

Keywords: soft tissue lipoma; mandible; radiography

Case report

A 19-year-old male presented for extractions of asympto- of the mandibular canal. Imaging using conventional CT
matic grossly carious # 17, 32 and malposed # 1, 16. A (Somaton Emotion CT scanner; Siemens Medical Sol-
panoramic radiograph, taken to evaluate the proposed utions USA, Inc., PA) revealed a deep, well-defined
extraction sites, revealed a well-defined radiolucency in concavity in the medial surface of the left mandibular
the area of the mandibular foramen of the left mandibular ramus that contained a well-defined soft tissue mass
ramus (Figure 1). The patients past medical history was (Figure 2). Because CT imaging strongly indicated a
non-contributory; he did not smoke and was a light benign lesion, and that the lesion could be removed in one
consumer of alcohol. The patient was asymptomatic and surgery, no exploratory biopsy or other imaging was
there was no associated mandibular or intraoral swelling or considered necessary.
detectable lymphadenopathy of the head and neck. During surgery, teeth # 1, 16, 17 and 32 were extracted.
The radiolucency revealed by the panoramic radiograph The tumour, which had been identified on a panoramic
(Figure 1) was located in the left mandibular ramus. On the radiograph and confirmed by CT, was approached via the
panoramic view, the lesion appeared to be within the anterior left ramus. An incision was made similar to that
inferior alveolar canal, with the most superior portion of used for mandibular osteotomies; the periosteum was
the lesion projecting through the mandibular foramen. It elevated, the tumour identified and carefully removed
was pear-shaped and approximately 1.8 cm 3 cm. The in toto using blunt dissection. Trauma to the inferior
broad base of the lesion was located superior and slightly alveolar canal and neurovascular bundle was avoided.
posterior to the mandibular foramen. The narrower end of No image of the surgical specimen is available.
the lesion overlaid the foramen. The lesion had a well- Microscopic examination of the excised soft tissue mass
defined sclerotic border that, inferiorly, was continuous revealed a circumscribed, but not encapsulated, aggregate
with the border of the mandibular canal. This feature of mature adipose cells. Vascularity was inconspicuous. No
enhanced the appearance of the narrower end of the lesion atypia or metaplasia was noted (Figure 3). This appearance
as being located within and expanding the proximal end was consistent with a diagnosis of classic lipoma.
A panoramic radiograph taken 6 months post-operatively
revealed that the radiolucency in the ramus was reduced in
*Correspondence to: Barry Pass, DDS, 1501 Crystal Drive, Suite 629, Arlington,
size (Figure 4a). Imaging 21 months post-operatively using
VA 22202, USA; E-mail: bpass@howard.edu cone beam CT (iCAT scanner; Imaging Sciences Inter-
Received 21 July 2005; revised 30 September 2005; accepted 10 October 2005 national, PA), then available at the surgeons office,
Soft tissue lipoma of the mandible
300 B Pass et al

Figure 1 A panoramic radiograph taken to evaluate teeth considered for extractions revealed a well-circumscribed radiolucency in the left mandibular
ramus. The right mandibular ramus was normal

Figure 2 Conventional CT imaging revealed a deep, well-defined concavity in the medial surface of the left mandibular ramus that contained a well-
defined soft tissue mass. Axial CT slices through the superior (a) and middle (b) sections of the lesion, respectively. Coronal CT slices through the anterior
(c) middle (d) sections of the lesion, respectively

Dentomaxillofacial Radiology
Soft tissue lipoma of the mandible
B Pass et al 301

Figure 3 Histological findings typical of classic lipoma: 10 low power view and inconspicuous vascular channels. The insert is a higher power view
(40 ) showing bland, small nuclei

demonstrated further resolution of the ramus defect (Figure Oral lipomas occur at various sites including the major
4b, c). Because of confidence in the surgery and in the post- salivary glands, buccal mucosa, lip, tongue, palate,
operative CT imaging, imaging with other modalities was not vestibule and floor of mouth. There are numerous case
considered necessary. There were no neurological deficits at reports describing lipomas in these various locations, with
this 21 month follow-up examination. many reports involving the tongue.3 9 The most common
anatomic site in the oral cavity has frequently been
reported as the buccal mucosa followed closely by the
Discussion parotid region.2,10 In the oral and maxillofacial region,
these tumours have a slight predilection for adult males.11
Lipomas are common benign soft tissue neoplasms of
The most recent review of lipomas of the oral and
mature adipose tissue, but are relatively uncommon in
the oral and maxillofacial region. The accepted classi- maxillofacial region by Furlong et al12 also reported a
fication of benign lipomas includes the categories: slight predilection for adult males. The parotid region was
classic lipoma; lipoma variants (e.g. angiolipoma, the most common site in this study, followed closely by the
chondroid lipoma, myolipoma, spindle cell lipoma); buccal mucosa. These two sites were then followed in
hamartomatous lesions; diffuse lipomatous proliferations; frequency by the lip, tongue, submandibular region, palate,
and hibernoma.1 floor of the mouth and vestibule. In the present report, the
The incidence of lipomas in the oral cavity is between lipoma on the medial aspect of the ramus is unique in its
approximately 1.0% and 4.5% of all benign oral lesions.2 location and radiographic appearance.

References

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Dentomaxillofacial Radiology
Soft tissue lipoma of the mandible
302 B Pass et al

Figure 4 (a) A 6 month post-operative panoramic radiograph shows a reduction in the size of the mandibular depression in the left ramus. (b, c) Imaging
21 months post-operatively, using cone beam CT, demonstrates further resolution of the ramus defect

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Dentomaxillofacial Radiology

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