Lipoma in the deep lobe of the parotid gland: A case report

Department of Otolaryngology and Head and Neck Surgery, Tokyo Medical and Dental University School of Medicine, Yushima, Bunkyo-ku, Tokyo 113-8519, Japan.
Auris Nasus Larynx (Impact Factor: 1.14). 11/2002; 29(4):391-3. DOI: 10.1016/S0385-8146(02)00018-4
Source: PubMed


We report here on a rare case of lipoma in the deep lobe of the parotid gland. MRI revealed that the tumour was situated mainly in the deep lobe and it extended posteriorly and medially into the space between the sternocleidomastoid muscle and the posterior belly of the digastric muscle, with slight extension into the parapharyngeal space. This tumour produced strong signals on T1- and T2-weighted MR images and weak signals on fat suppression images. In addition, MRI clearly showed the margin of the tumour, which enabled us to readily distinguish the tumour from the surrounding adipose tissue. The images suggested a diagnosis of deep lobe parotid lipoma with posteromedial extension to the sternocleidomastoid muscle, which proved true at surgery. We thus believe that MRI is highly useful, perhaps even necessary, in diagnosing tumours of the head and neck.

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    • "MRI can also accurately diagnose lipomas preoperatively by comparison of signal intensity on T1-and T2-weighted images [5,16]. Moreover, the margin of a lipoma is clearly defined by MRI as a 'black-rim', enabling lipomas to be distinguished from surrounding adipose tissue, a distinction that cannot be made from CT images [8]. "
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    ABSTRACT: Lipomas are common benign soft tissue neoplasms but they are found very rarely in the deep lobe of parotid gland. Surgical intervention in these tumors is challenging because of the proximity of the facial nerve, and thus knowledge of the anatomy and meticulous surgical technique are essential. A 71-year-old female presented with a large asymptomatic mass, which had occupied the left facial area for over the past fifteen years, and she requested surgical excision for a cosmetically better facial appearance. The computed tomography (CT) scan showed a well-defined giant lipoma arising from the left deep parotid gland. The lipoma was successfully enucleated after full exposure and mobilization of the overlying facial nerve branches. The surgical specimen measured 9 x 6 cm in size, and histopathology revealed fibrolipoma. The patient experienced an uneventful recovery, with a satisfying facial contour and intact facial nerve function. Giant lipomas involving the deep parotid lobe are extremely rare. The high-resolution CT scan provides an accurate and cost-effective preoperative investigative method. Surgical management of deep lobe lipoma should be performed by experienced surgeons due to the need for meticulous dissection of the facial nerve branches. Superficial parotidectomy before deep lobe lipoma removal may be unnecessary in selected cases because preservation of the superficial lobe may contribute to a better aesthetic and functional result.
    World Journal of Surgical Oncology 02/2006; 4(1):28. DOI:10.1186/1477-7819-4-28 · 1.41 Impact Factor
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    • "However, this incidence is as high as 80% (four in five reported deep parotid lipoma cases) after the surgery for deep lobe parotid lipoma. As the lipoma resembles the appearance of the surrounding normal tissue, it is probably to increase the facial nerve dysfunction [2] [3] [4] [5]. "
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    ABSTRACT: We would like to present our experience in management of lipomas arising in the deep lobe of the parotid gland, which were diagnosed and operated in our clinic from the point of complication/morbidity, and recurrence, in line with the literature. Five patients with lipoma found in the deep lobe of the parotid gland, diagnosed and treated at our clinic in the 12-year period between March 1992 and March 2004, were included in this study. Limits of the tumors were determined by computed tomography (CT), and/or magnetic resonance imaging (MRI). Preoperative fine needle aspiration biopsy (FNAB) was also performed. Through a classic parotidectomy incision, the parotid gland was exposed. Full exposure of the facial nerve and its branches was performed. The removal of deep lobe parotid lipomas was achieved by enucleation in all cases. Postoperative complication/morbidity and recurrence were evaluated. The most common symptom was an otherwise asymptomatic mass on the parotid region and/or upper lateral neck. One of five patients was presented with medial displacement of the lateral pharyngeal wall, and tonsil as the additional physical finding. Preoperative radiologic evaluation results revealed that CT and/or MRI scans accurately localized 100% of the tumors in relation to the deep lobe of the parotid gland. FNAB did not enable us to make a diagnosis of lipoma in four of the cases. Total resection was achieved in all cases. Temporary facial nerve paralysis, due to the dissection of the facial nerve, did not occur in any cases. There was no recurrence of the tumors after a mean follow-up of 60 months. Assessment of the exact location of the tumor is an important consideration for selection of the appropriate surgical approach. Different from lipomas found in other locations, those observed in the parotid gland cannot be easily resected by simple dissection. Resection of these tumors requires full exposure of the facial nerve.
    Auris Nasus Larynx 04/2005; 32(1):49-53. DOI:10.1016/j.anl.2004.09.004 · 1.14 Impact Factor
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    ABSTRACT: Lipomas of the parotid are interesting lesions because they rarely occur and are not considered in the preoperative diffential diagnosis. We present a case of a lipoma in the left parotid of a 67-year-old male. This mass developed slowly over 10years. Limited superficial parotidectomy was done. Neither tumor recurrence nor Frey's syndrome was observed 2years after the surgery. The essential factor in the differential diagnosis of a mass in the parotid glands is whether it is benign or malignant. Although lipomas of the parotid rarely occur, they should be taken into consideration in the preoperative diffential diagnosis. KeywordsLipoma-Parotid gland-Superficial lobe
    European Journal of Plastic Surgery 08/2010; 33(4):215-218. DOI:10.1007/s00238-010-0400-1
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