Kaniz Hasina

Youngest patient of the world with largest lipoma on the floor of the mouth: report from Bangladesh

An 8-year-old girl presented in the surgery outdoor of Dhaka Medical College Hospital with complaints of a mass in the oral cavity for 3 years. According to the history of the patient, as told by her mother, the child was quite alright up to the age of 5 years. Then she developed a mass in the oral cavity which is gradually increasing in size. The mass is neither associated with difficulty in feeding or swallowing nor associated with respiratory distress. On examination it was somewhat dumbbell shaped extending on both sides of the floor of mouth, more on left side, bimanually palpable, non tender, measuring about 9 cm/3– 5 cm, with ill defined margins and smooth surface, free from skin, firm in consistency, transilumination test was negative, seemed non fluctuating and non compressible. The lump showed no change in size with meal. The lump was clinically diagnosed as a case of sublingual dermoid. Fine needle aspiration cytology (FNAC) of the lump was done preoperatively and report revealed lipoma (Fig. 1). Then for surgical management, the patient was admitted under Pediatric Surgery Department of DMCH. Since it was a big one, neck approach would have been easier but for better cosmetic result, the lump was excised through intra oral approach under general anesthesia and it was difficult. A midline incision was given in the floor of the mouth under the tongue with needle cautery. After giving incision, mylohyoid muscles were separated in the midline and then lump was found. The lump was carefully dissected preserving the submandibular salivary glands and their ducts. Some portion of the lump was extended deep to the genioglossus muscle which was initially difficult to separate but with careful finger and sharp dissection whole