Introduction: A lipoma is a tumor of soft tissue that occurs very rarely in the oral cavity. We present a case of an infant presenting with stridor who was found to have two soft palate masses consistent with introral lipomas causing airway obstruction.
Case Report: The patient is a 9 day old infant who was born at full term with dysmorphic features. He was noted to have stridor and increased work of breathing since birth, but it improved within the first few days of life. He was transferred to our institution from an outside hospital for neurological and genetic workup, and he subsequently underwent an MRI brain under GA with an LMA. Afterwards, he developed worsening stridor that improved with CPAP. OHNS was consulted, and upon examination under flexible nasolaryngoscopy, a soft palate mass that extended into the oropharynx was seen. Then patient was taken to the OR for excision and biopsy. At this point, the patient was tachypneic and had an increase work of breathing. Given concern for a difficult intubation as well as airway obstruction with positive pressure ventilation, we decided to perform an awake nasal fiberoptic intubation. Initial attempts by the anesthesiologist were not successful due to secretions and grimacing. The OHNS fellow attempted afterward, and after suctioning was able to secure a 3.5mm ETT in the left nare. Examination revealed two 3cm pedunculated soft tissue masses emanating from the superior tonsillar fossa bilaterally, as well as a bifid uvula and ankyloglossia. Patient underwent resection of the masses, partial tonsillectomy, and frenulectomy. He was stable on pressure support and was extubated POD#2. Patient afterward was noted to have mild intermittent stridor but was stable on room air with no desaturations or increased work of breathing. Biopsy from resected masses revealed lipomatosis.
Discussion: This case illustrates a rare presentation of a lipoma that resulted in an unusual cause of stridor. Oral lipomas have an incidence of 1-5%, with no cases reported earlier than 6 weeks of age.1,2 Although rare, it is a diagnosis to consider when evaluating a patient with stridor. If there is a need to intubate, it is best to involve OHNS colleagues and perform flexible awake fiberoptic intubation if possible.
References:
- Fregnani ER, Pires FR, Falzoni R, Lopes MA, Vargas PA. Lipomas of the oral cavity: clinical findings, histological classification and proliferative activity of 46 cases. Int J Oral Maxillofac Surg. 2003 Feb;32(1):49-53.
- Furlong MA, Fanburg-Smith JC, Childers EL. Lipoma of the oral and maxillofacial region: Site and subclassification of 125 cases. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2004 Oct;98(4):441-50.
