Lipomas are common benign tumors of adipose tissue that can occur under the skin anywhere in the body. However, their occurrence in the oral cavity is rare, accounting for only 1% to 4% of all benign oral mesenchymal neoplasms [1]. Lipomas predominantly affect individuals aged between 40 and 60 years and are uncommon in children. Although intraoral lipomas are rare, when present in the oral cavity, they are frequently found in the buccal mucosa [2].

Lipomas can be classified as simple lipomas or various histological subtypes. Although a differential diagnosis is required for intraoral myxoid lipoma subtypes, very few cases have been reported to form the basis for differentiation [2]. To date, only five articles in the English literature have reported oral myxoid lipomas with details on patient age, sex, and site of onset (Table 1) [2-6]. This study aimed to present the clinical and histological features of two rare cases of myxoid lipoma, one in the right submandibular area of a 67-year-old male and the other in the lower lip of a 3-year-old boy.

Soft-tissue lesions in the facial and oral regions require a wide range of differential diagnoses, emphasizing the critical need for accurate differentiation. Oral and maxillofacial surgeons must skillfully differentiate soft-tissue lesions occurring in the perioral and mandibular regions, make an accurate prognosis, discuss the situation with the patient, and proceed with appropriate treatment. Previous studies focusing on myxoid lipomas in the oral and maxillofacial area are limited and thus insufficient for differential diagnosis. The reported cases predominantly involved individuals who were middle-aged, consistent with the typical age range for patients with lipomas [2-6]. Table 1 exclusively includes the studies published in English that comprehensively detailed the age and sex of the patient and the specific site of lesion occurrence.

Although lipomas are the most common benign mesenchymal tumors, they occur less frequently in the oral and maxillofacial regions. However, according to a recent study, lipomatous tumors constitute a significant proportion of benign tumors of the oral mucosa [7]. The most common intraoral sites are the buccal mucosa and the vestibule, with fewer cases on the tongue, floor of the mouth, and lips. The pathogenesis and etiology of lipomas are uncertain, but they may develop in response to external factors such as trauma and chronic irritation [1,8].

Local surgical excision is an appropriate treatment option for benign masses in the oral and perioral areas. The treatment of lipomas does not vary according to the variant; however, subtypes with infiltrative growth, such as intramuscular lipomas, may exhibit high recurrence rates [1]. Furthermore, myxoid lipomas must be distinguished from benign and malignant lipomatous tumors with abundant mucoid substances, such as spindle cell lipomas with myxoid changes and myxoid liposarcomas [2]. Because the clinical features of myxoid lipomas are similar to those of mucoceles in the lower lip and because of their rarity in children, myxoid lipomas are often misdiagnosed. Accurate patient prognosis necessitates differential diagnosis and pathological assessment. Given their distinct pathological features, myxoid lipomas require specific management to prevent recurrence and progression. The clinical ability to recognize benign mucosal neoplasms by visual inspection is relatively poor, and benign mucosal neoplasms are often clinically unsuspected. For most benign diseases requiring differential diagnosis, preserved local surgical excision is the first choice [2], and postoperative biopsy of every excised oral mucosal mass is recommended [7].

In conclusion, histopathological examination is crucial for the accurate diagnosis and prognosis of connective tissue lesions in the head and neck region, including various histological subtypes of lipomas. This underscores the importance of a thorough examination regardless of the site or age of onset.