Traumatic pseudo-lipoma in 3-year-old child
A 3 year old female patient was referred from a pediatrician to the Department of Pedodontic and Preventive Dentistry with a chief complaint of extra- and intra-oral swelling and pain on the right side of face. Child's father gave history of appearance of extra-oral swelling 5 days back with pain, discomfort, drooling of saliva from mouth and inability to eat. Overlying cheek skin was normal and swelling was non-tender. The intra-oral swelling was first noticed approximately 1 month ago as a small reddish pink growth which increased gradually [] The patient reported to the department after 3 days with complain of intense pain and increased extra-oral swelling and compressed intra-oral swelling []. Gross clinical intra-oral examination of the lesion revealed the presence of a reddish pink, ovoid, smooth, pedunculated, non-ulcerated, freely mobile, tender swelling of approximately 3.0 × 2.0 × 1.5 cm size, located between the maxillary and mandibular primary second molar regions. The lesion was found to be soft, fluctuant in consistency and freely mobile on palpation. The child was having the habit of placing toothbrush for more than 1h daily while brushing teeth. She used to bite on it while keeping it in the right buccal vestibule from last 6 months.\nDifferential diagnosis of the mass was given as a pyogenic granuloma, traumatic fibroma, haemangioma, infected lipoma, inflammatory pseudotumour, infected benign minor salivary gland tumor, foreign body granuloma and traumatic neuroma. The child was prescribed antibiotics, analgesic and antiseptic mouthwash for 3 days to reduce infection, inflammation, pain as well as post-operative complications while healing. The intra-oral growth was seen pale yellow in color and shrunken after 3 days. As the patient was highly uncooperative (Frankl rating I), after complete hematological investigations, Surgical excision of the mass was done under local anesthesia with soft-tissue diode laser (Doctor Smile Wiser Laser) at 2W continuous pulse. Tissue mass was excised in-toto from the base of buccal mucosa and sent for histopathological examination to the Department of Oral Pathology []. An attempt was made to express saliva from the parotid duct to identify the location of the parotid papilla and confirm that it is not severed or damaged []. Patient was recalled after 1 week and 3 months for follow-up of wound healing. Manoeuvre to express saliva from Stensen's duct was repeated to make sure that it was not damaged.\nMacroscopic examination revealed one soft-tissue of a reddish pink, ovoid, firm in consistency, smooth surfaced, pedunculated, non-ulcerated mass of approximately 3.0 × 2.0 × 1.5 cm size []. Histological examination of the tissue revealed the presence of adipose tissues with non-ulcerated overlying epithelium. The overlying epithelium is atrophic stretched parakeratinised stratified squamous epithelium. Presence of marked edema and diffuse proliferation of capillaries along with formation of granulation tissue, composed of moderately dense polymorphonuclear neutrophillic and lymphoplasmocytic infiltrate []. The connective tissue stroma consists of dense collagen bundles and lobules of mature adipocytes with no cellular atypia. Compressed blood vessels engorged with Red Blood Cells were also evident in the connective tissue stroma. The overall histo-pathological features were confirmatory of traumatic pseudolipoma (Traumatic herniation of buccal fat pad) [].