Intramuscular lipoma is a benign soft tissue tumor that accounts for 1.8 to 2% of all lipomas, which often originates from the large muscles in the extremities, rarely in the oral region. This time, we experienced a case of intramuscular lipoma on the undersurface of the left side of the tongue and reported the overview with literal consideration. The patient was a 62-year-old male, and complained of indolent swelling on the undersurface of the left side of the tongue and sought medical attention. Relatively well-demarcated low-density area approximatel 10 mm in greatest dimension was observed in the left side of the tongue tip on the CT images, while relatively well-demarcated area with hyperintensities in the inside and partially muscular tissues and partially linear portion showing the same signal with muscular tissues on T1- and T2-weighted MRI images. A diagnosis of lipoma was made based on clinical findings and imaging findings of the CT and MRI, and removal was performed using general anesthesia. Histopathologically, the fat tissues had no surrounding membranes and were lobulated and grew into the muscular layer, tumor cells were large, adipocyte-like cells with clear cytoplasm grew into the muscular layer, and a diagnosis of intramuscular lipoma was made. We searched for and collected case reports on intramuscular lipoma in the stomatognathic area in Japan and identified 14 cases including this case. Particularly, 3 cases of intramuscular lipoma on the undersurface of the tongue including this case were identified and the location was considered to be rare. Recurrence rate of intramuscular lipoma was high level of 3% to 62.5%, and it is important to examine much imaging information in detail from imaging diagnosis with CT and MRI examinations. This patient was well after surgery without signs of recurrence.

Objectives: The alveolar ridge resorbs and collapses following tooth removal which continues to be a major concern for practitioners. Many researchers concluded that buccal aspect of the ridge is more prone to resorption, as it is primarily supplied by the periodontal tissues and ligaments of the tooth1. Recently, several papers were published concerning the socket shield technique explaining how to maintain the ridge width and height. Socket shield technique aids at retaining the buccal fragment of root in place thus placing the implant behind the lingual aspect of that fragment so as aid in preventing the collapsing of the buccal bone. This would help in improving aesthetics especially during immediate implant placement in the anterior maxillary region(schroop et al, 2003).

 

Materials And Methods: The patient passed through phase I therapy (Supragingival scaling, subgingival debridement and oral hygiene instructions) before any surgical procedures. - CBCT scan using On Demand 3D is performed to record preoperative ridge width and height measurements and specially crestal bone in aesthetic area .The non-restorable tooth is separated using a partial extraction therapy bur, then the lingual portion is removed atraumaticaly thus retaining the buccal fragment of the tooth - The osteotomy site is then done using appropriate drill sizes - A paralling pin is applied to assure the implant future position behind the root fragment and a periapical x-ray is taken - The implant is then inserted in place and another periapical is then taken shown in on surgery day and a cone beam is done after 12 month post-operative(hurzeler, 2010).

 

Results: Buccal bone was measured by the use of CBCT, it was 0.98mm buccolingual. When measured after 6 months it was 0.96mm. When measured after 2 years follow up, it was the same 0.96mm which indicated that buccal bone was not resorbed between 6 months and 2 years follow-up post-operative.
 

Conclusion: Socket shield technique provides a future solution to prevent collapse of thin buccal bone with immediate implantation (Baumer et al, 2015)