Lipoma of the cheek: a case report

Introduction

A lipoma is the most common benign mesenchymal tumor consisting of mature adipocytes (1). Although it can occur in various body regions, its presence in the head and neck area is comparatively rare, accounting for approximately 13% of all lipomas (2). The most frequently affected regions include the buccal mucosa, lips, tongue, palate, vestibule, floor of the mouth, and retromolar area. The cheek is an even less common site, making lipomas in this region of particular clinical importance (3).

These tumors generally manifest as well-defined, soft, mobile,and painless subcutaneous masses. Nonetheless, depending on their size and location, they may occasionally induce cosmetic or functional discomfort (4). The position and size of the tumor can indeed result in speech and mastication difficulties (5).

The diagnosis is typically based on clinical evaluation and corroborated by imaging modalities such as ultrasound, computed tomography (CT), and magnetic resonance imaging (MRI). These techniques assist in delineating the extent of the lipoma and distinguishing it from alternative lesions.

The preferred approach is surgical excision, which typically results in complete recovery and a low recurrence rate (1% to 2%) owing to their well-defined margins (6).

This case report aims to present the authors’ experience in managing the clinical case of an adult female patient with a lipoma in the cheek region. The lipoma was treated with surgical excision, resulting in no recurrence or complications. This underscores the importance of an accurate pre-operative approach to improving prognosis.

Case report

A 60-year-old female patient presented to the Department of Odontostomatological and Maxillofacial Sciences at “Sapienza” University of Rome, specifically to the Odontostomatological Clinic, in March 2025, due to a swelling in her cheek region. The patient reported a circular, painless, and slow-growing swelling that had been present for one year.

The clinical examination corroborated the existence of a superficial, mobile, soft, and non-tender mass measuring approximately 2.5 cm by 1.5 cm by 1 cm. The skin overlaying the lesion exhibited no signs of inflammation. There was no palpable laterocervical lymphadenopathy, masticatory impairments, or alterations in facial sensation. Based on the patient’s history and clinical findings, a provisional diagnosis of lipoma was established.

Given the clinical findings, ultrasound imaging, and MRI, which indicated a diagnosis of lipoma, combined with the patient’s aesthetic concerns, surgical excision of the mass under local anesthesia was scheduled (Figure 1–8).

The imaging demonstrated a well-defined, oval, hyperechoic mass exhibiting features consistent with a lipoma, with no evidence of infiltration into adjacent tissues or musculature.

During the procedure, a cold blade incision was made on the skin overlying the swelling, following the natural lines of the cheek to minimize cosmetic impact.

A yellowish, lobulated, well-encapsulated mass, clearly demarcated from the surrounding tissues, was identified and completely enucleated through a layered dissection. A first layer of interrupted 3/0 Vicryl absorbable sutures was then used to approximate the muscle plane, followed by interrupted 3/0 Vicryl sutures for the skin plane. The patient tolerated the procedure well, with no intraoperative complications.

The excised specimen was forwarded for histopathological analysis, corroborating the diagnosis of lipoma. The analysis demonstrated adipose connective tissue in continuity with minor segments of fibrous and striated muscle tissue, associated with focal chronic lymphomononuclear inflammation, with some vascular and nervous structures at the periphery, all devoid of atypia.

The patient’s recovery was uneventful in the postoperative period, and optimal healing was observed at the one-week postoperative follow-up for suture removal.

Discussion

Lipomas of the cheek, although infrequent, pose a diagnostic challenge in distinguishing them from other lesions in the parotid or masseteric region (7, 8). The evaluation of this condition invariably begins with a meticulous medical history and a comprehensive physical examination, during which patients generally report the presence of a slow-growing, asymptomatic, or minimally symptomatic swelling. Upon physical examination, a lipoma manifests as a subcutaneous, soft, elastic, mobile mass situated over deeper planes, non-tender upon palpation, with the overlying skin remaining intact and unaltered (9, 10).

The differential diagnosis between lipomas and other tumor masses, particularly those occupying the parapharyngeal spaces, presents a significant clinical challenge. While lipomas typically present as mobile, non-painful masses, their distinction from other lesions can be difficult when located in complex anatomical areas like the parapharyngeal space. This is because malignant tumors, such as adenoid cystic carcinoma or lymphoma, can also present with similar clinical features, although their consistency may vary. CT and MRI are essential diagnostic tools (11).

Pre-operative diagnosis primarily relies on imaging. Ultrasound is the preferred initial imaging modality due to its non-invasiveness, cost-effectiveness, capacity to differentiate between solid and cystic lesions, and ability to provide information on vascularity. In cases of lipomas, ultrasound generally reveals a hyperechoic, well-defined mass with a homogeneous echostructure (12, 13). In specific instances or when diagnostic uncertainty exists—such as for deeper or larger lesions, or those with ambiguous relationships to vital structures—magnetic resonance imaging (MRI) is considered the gold standard. MRI offers more detailed information regarding the extent of the mass and its relationships with adjacent anatomical structures, including the facial nerve and Stensen’s duct—additionally, MRI aids in distinguishing lipomas from other soft tissue lesions (12, 13). On MRI, lipomas are typically characterized by a hyperintense signal on T1-weighted sequences and fat signal suppression on T2-weighted fat-suppressed sequences, confirming their adipose composition. Computed tomography (CT) may be an alternative to MRI, particularly when MRI is contraindicated; however, it exposes the patient to ionizing radiation and offers lower soft tissue resolution than MRI (13, 14). Fine-needle aspiration (FNA) biopsy or incisional/excisional biopsy are not routinely performed for clinically evident lipomas, but may be considered when malignancy (e.g., rapid growth, firm consistency, fixation to deep planes, pain) is suspected to exclude liposarcoma. Nonetheless, liposarcoma is infrequent in the cheek region (8, 12–14).

The etiology of lipomas remains incompletely understood; however, genetic predispositions, recurrent local trauma, or metabolic disturbances are believed to contribute to their development (4). Most lipomas are asymptomatic, and the decision to pursue intervention is frequently motivated by aesthetic considerations, as exemplified by our patient’s case. Nonetheless, progressive enlargement may result in compression symptoms or functional impairments, such as difficulties in mastication or mouth opening if the lipoma is situated deeply and adjacent to masticatory muscles, or altered sensation if it compresses neural branches (15, 16).

Surgical excision is the preferred method for treating lipomas (17, 18, 19). The objective is to achieve complete removal of the lesion to prevent recurrence; hence, it is essential to preserve an intact capsule throughout the procedure (8). In the case of simple lipomas, the recurrence rate is typically low, less than 5%. Specifically, in the cheek region, the proximity to critical anatomical structures such as the facial nerve and its branches and Stensen’s duct necessitates meticulous surgical technique. Identification and preservation of these structures are of utmost importance to avoid complications. Although complications arising from untreated pathology are generally infrequent, they may include: increased size (where the lipoma continues to enlarge, potentially complicating excision and increasing the risk of compression on adjacent structures), nerve compression (although less common, a growing lipoma can exert pressure on branches of the facial nerve, leading to facial weakness or paralysis, or on sensory branches, resulting in paresthesias or pain), and aesthetic or functional discomfort (20–21).

Utilizing aesthetically favorable incisions, such as those along Langer’s lines or within the nasolabial fold or submandibular sulcus, is essential to minimize visible scars and achieve an optimal aesthetic outcome. In certain instances, liposuction has been investigated as an alternative for very small and superficial lipomas. Nonetheless, surgical excision remains the gold standard for ensuring complete removal and facilitating histopathological analysis (17–22).

Specific surgical complications in this region during lipoma excision include injury to the facial nerve and/or Stensen’s duct. Facial nerve injury is regarded as the most concerning complication, potentially resulting in temporary or permanent facial paralysis, characterized by an inability to close the eye and drooping of the mouth corner. The utilization of intraoperative facial nerve monitoring can mitigate this risk. Additionally, injury to Stensen’s duct may lead to the development of a salivary fistula or a sialocele (23, 26).

The following clinical case underscores the significance of precise pre-operative evaluation, encompassing a comprehensive patient history, physical examination, and the selection of appropriate surgical techniques for the management of cheek lipomas. Histopathological confirmation is consistently advised to exclude more aggressive differential diagnoses, such as liposarcoma (despite its rarity in the cheek) or other benign or malignant soft tissue neoplasms, even when such diagnoses are clinically unlikely (25). This methodology ensures patient safety and the accuracy of the pathological diagnosis, thereby supporting favorable prognostic outcomes.

Conclusion

Lipomas are ubiquitous benign mesenchymal tumors, but their occurrence in the cheek region is a rare and often underestimated clinical entity. Their rarity and initially asymptomatic nature can delay diagnosis and lead to misinterpretations. This report underscores the importance of a comprehensive diagnostic approach integrating accurate clinical evaluation with advanced imaging modalities. This multifactorial assessment is indispensable for precisely characterizing the lesion, including its size, depth, and relationship with vital structures, and, critically, distinguishing it from malignant mimics like liposarcoma. The benign nature of lipoma does not diminish the complexity of its management in such a critical anatomical location. Complete surgical excision remains the treatment of cheek lipomas, offering a highly effective and definitive solution with an excellent prognosis and minimal risk of recurrence. Meticulous surgical technique is paramount to ensure total tumor removal while preserving the delicate neurovascular structures of the facial region. This clinical case serves as a valuable reminder for clinicians to maintain a high index of suspicion for lipomas in the differential diagnosis of oral and maxillofacial swellings, even in the presence of atypical presentations or in the absence of pain. By adopting a rigorous diagnostic and therapeutic approach, early and accurate diagnosis can be achieved, leading to timely and appropriate management that optimizes patient outcomes and minimizes potential complications.