What is the recommended treatment for an oral lipoma in the buccal vestibule?

Management of Oral Lipoma in the Buccal Vestibule

Surgical excision is the standard treatment for oral lipomas in the buccal vestibule, providing excellent rates of long-term local control with low recurrence risk. 1, 2

Diagnostic Approach

• Oral lipomas are benign soft tissue tumors that occur infrequently in the oral cavity (1-4% of benign oral tumors), with the buccal mucosa being the most common site 3, 4
• Clinical presentation typically includes:
  • Asymptomatic, soft, smooth-surfaced nodular mass 4
  • Yellowish coloration visible through the thin epithelial surface 5
  • Slow-growing nature with potential to cause functional issues if large enough 3
• Imaging studies may be necessary for proper assessment:
  • Ultrasound can serve as an effective initial triage tool to confirm lipomatous nature 1
  • MRI with expert review is recommended for diagnostic uncertainty, differentiating between benign lipomas and atypical lipomatous tumors with up to 69% accuracy 6, 2

Treatment Algorithm

Primary Treatment: Surgical Excision

• Complete en bloc surgical excision is the standard treatment for oral lipomas in the buccal vestibule 2, 7
• Benefits of surgical excision include:
  • High success rate with low recurrence risk 2
  • Definitive diagnosis through histopathological examination 7
  • Resolution of functional issues if the lipoma is causing difficulty in speech or mastication 3

Surgical Considerations

• The operation should be performed by a surgeon specifically trained in oral soft tissue procedures 6
• Marginal resections as complete en bloc specimens provide excellent rates of long-term local control 6, 2
• For larger tumors in the vestibule, preoperative imaging (MRI) may be necessary if the lesion is in close proximity to important anatomical structures such as the mental nerve 7

Histopathological Variants

• Classic lipoma is the most common variant (48% of oral lipomas), resembling normal adipose tissue 8
• Other variants include:
  • Fibrolipoma - contains significant fibrous connective tissue 5, 8
  • Intramuscular lipoma - invades skeletal muscle bundles 5, 8
  • Angiolipoma - contains numerous small blood vessels 5, 8
  • Spindle cell lipoma - contains a mixture of uniform spindle cells 5, 8

Post-Treatment Follow-up

• Following surgical excision and post-operative wound care, patients can be discharged to primary care 1, 2
• Re-referral is only necessary if there is clinical suspicion of recurrence 1, 2
• Recurrence rates for properly excised oral lipomas are very low 7

Special Considerations

• If the lipoma is large enough to cause functional impairment (speech difficulties, mastication problems), surgical intervention should be prioritized 3
• Red flags requiring further investigation include:
  • Rapid increase in size
  • Pain
  • Concerning features on imaging
  • These may suggest malignant transformation and require urgent referral 1