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lipomas are benign tumors comprising mature adipocytes and they can occur anywhere that adipocytes are present .
they account for 15% to 20% of all benign tumors and 4% to 5% of benign tumors in the head and neck region12 .
intraoral lipomas are rare and comprise only 0.1% to 5% of all benign tumors in the intraoral cavity3 .
although lipomas can occur anywhere in the intraoral cavity , the major salivary glands ( especially the parotid gland ) are most frequently affected , followed by the buccal mucosa , lip , tongue , palate , floor of the mouth , and gingiva4 .
small lipomas in the intraoral cavity may be asymptomatic , but large tumors may cause discomfort , difficulty chewing , dysphagia , and dyspnea . typically , there is no pain or tenderness .
if they occur in the parotid gland , however , conservative treatment is preferred to preserve the facial nerve6 .
herein , we review the literature and report a case of intraoral lipoma on the mandibular vestibule treated by surgical excision .
a 56-year - old woman visited the department of oral and maxillofacial surgery at hallym university kangdong sacred heart hospital because of gingival swelling that started one month prior .
the swelling had worsened over the previous two weeks and she had discomfort while eating . upon intraoral examination , we observed swelling at the right first premolar mandibular vestibule and palpated a relatively solid mass , measuring approximately 2.01.5 cm and covered with normal gingival tissue .
we did not observe any masses at other sites in the intraoral cavity and cervical lymph nodes were not swollen .
a ) the patient was treated for diabetes in our endocrinology department and otherwise had no predisposing medical or familial history . in consultation with the endocrinology specialist ,
surgical excision and general anesthesia was planned . because the mass was located adjacent to the mental foramen , a precise dissection was necessary to ensure minimal nerve damage .
biochemical tests and urinalysis results were unremarkable except for values associated with diabetes ( blood sugar test 96 - 254 mg / dl , hba1c - national glycohemoglobin standardization program [ hba1c - ngsp ] 8.0% , hba1c - international federation of clinical chemistry [ hba1c - ifcc ] 64 mmol / mol ) . computed tomography of the neck revealed an ill - defined hypodense mass approximately 2 cm in diameter at the first right mandibular premolar.(fig .
c ) the mass was surgically excised under general anesthesia . the mass was encapsulated and well - defined within the surrounding tissue and measured approximately 1.11.00.6 cm.(fig . 3 , 4 )
histopathologic examination revealed thin septa of connective tissue separating lobules of adipose tissue formed by mature , uniform adipose cells.(fig .
was noted at 1-year follow - up and the patient did not complain of numbness.(fig .
6 ) this report was approved by the ethics committee at hallym university kangdong sacred heart hospital ( 14 - 3 - 04 ) .
lipomas can occur in patients of all ages and are more common in females than males .
intraoral lipomas are rare , but are more likely to affect males over 40 years of age8 . from a clinical standpoint ,
the period from when patients notice the lipoma to when they seek medical care ranges from 1 month to 10 years , with a mean of 2 years89 .
the most affected areas are buccal mucosa , lip , tongue , palate , floor of the mouth , and gingiva .
lipomas mostly appear as round or oval shaped well - defined rigid masses . in some cases ,
it is usually easy to diagnose lipomas based on the macroscopic appearance except when they are located deeply .
the histopathologic differential diagnosis includes fibroma , leiomyoma , pleomorphic adenoma in a minor salivary gland , papilloma , epidermoid cyst , and others10 .
on histopathologic examination , fibromas have a nodular mass of fibrous connective tissue covered by stratified squamous epithelium .
leiomyomas are well - circumscribed tumors that consist of interlacing bundles of spindle - shaped smooth muscle cells .
this lack of complete encapsulation is more common for minor gland tumors , especially along the superficial aspect of palatal tumors beneath the epithelial surface .
papillomas are characterized by a proliferation of keratinized stratified squamous epithelium arrayed in finger - like projections with fibrovascular connective tissue cores .
. a well - developed granular cell layer is seen , and the lumen is filled with degenerating orthokeratin11 . on histopathological analysis , fibro - connective tissue and blood vessels are observed between mature adipocyte in lipomas , and around that , a thin fiber tabernacle is encircled .
there is a phospholipid vesicle in the center of the adipocyte , and cytoplasm and nuclei are observed at the border .
adipocytes within lipomas are multi - lobed and divided by fibro - connective tissue and blood vessels .
about 80% are the general type , composed primarily of mature adipocytes ; 20% are classified as fibro - lipomas and are composed of more fibrous tissues , and angiolipomas are composed of more angiotissues2912 .
most lipomas occur singly , but they can be multiple1013 and then should be distinguished from liposis . the recommended treatment for lipoma is surgical excision .
superficial lipomas are easily removed , but if they are positioned deeply , excision is difficult .
after surgical excision , relapse and malignant alteration are rare9 . in this case , to present there have been no specific changes after the excision .
lipomas are associated with chronic stimulation , trauma , heredity , familial history , and have recently been correlated with diabetes .
das gupta14 argued the hypertrophy theory that obesity and local growth of adipose tissue may both be responsible for the formation of a lipoma .
the relationship between obesity and diabetes is well known . in 1996 , suzuki et al.15 reported a case of mitochondrial diabetes caused by trna mutation . over 12 years of follow - up , they observed two important clinical features : ( 1 ) lower limb paresthesia manifesting even with mild hyperglycemia and ( 2 ) lipoma ( round , 10 mm diameter ) manifesting at age 44 over the left breast .
berkovic et al.17 described cases of four patients : two with multiple symmetric lipomatoses and two with lipoma and multisystem disorders ; all patients had mitochondrial dysfunction .
holme et al.18 suggested that mitochondrial dna mutations may be either a direct or an indirect cause of perturbation of the maturation process of adipocytes . in view of this
, diabetes patients are exposed to dna mutations and a high frequency of lipoma occurrence in diabetes patients can be assumed .
so when a diabetic patient complains of an asymptomatic gingival swelling in the intraoral area , lipoma should be prominent in the differential diagnosis .
intraoral lipomas are a rare clinical entity , comprising only 0.1% to 5% of all benign tumors in the intraoral cavity . 
 a 56-year - old woman suffering from diabetes presented with this relatively rare intraoral lipoma and was treated by surgical excision under general anesthesia . because the mass was located adjacent to the mental foramen , a precise dissection was necessary to ensure minimal nerve damage . 
 no abnormalities or recurrence was noted at 1-year follow - up and the patient did not complain of numbness . 
 we studied the occurrence of oral lipoma in this diabetic patient and reviewed the relationship between oral lipoma and diabetes in the literature .