# Excision of a Lipoma Between the Parotid Gland and Masseter Muscle via the High Perimandibular Approach: A Case Report

## TL;DR

A 72-year-old man had a cheek lipoma successfully removed using a high perimandibular approach, avoiding nerve and duct damage with good recovery.

## Contribution

Demonstrates the high perimandibular approach as a safe and effective method for cheek tumor removal.

## Key findings

- The high perimandibular approach allowed safe en bloc excision of the lipoma without facial nerve or parotid duct injury.
- The surgical scar was well concealed and there was no recurrence at 4 months post-surgery.
- Histopathology confirmed the diagnosis of lipoma, aligning with preoperative imaging findings.

## Abstract

Subcutaneous tumors in the cheek region present a surgical challenge due to the complex anatomy involving the facial nerve and parotid duct. We report the case of a 72-year-old male with a soft, mobile mass in the left subcutaneous cheek. Magnetic resonance imaging revealed a well-defined 3 cm lipomatous lesion situated between the parotid gland and the masseter muscle. The mass was hyperintense on T1- and T2-weighted images and hypointense on fat-suppressed T2-weighted imaging, consistent with a lipoma. The tumor was successfully excised en bloc using the high perimandibular approach, which is a transmasseteric technique originally developed for mandibular condylar fractures. A 5 cm incision was placed just inferior to the mandibular border, and dissection was performed between the masseter and parotid gland under facial nerve monitoring. No injury to the facial nerve or parotid duct occurred. The postoperative course was uneventful, with no complications such as facial nerve palsy or salivary leakage. Histopathological examination confirmed the diagnosis of lipoma. The surgical scar was well concealed, and there was no recurrence at 4 months. This case shows that the high perimandibular approach provides excellent access for resection of subcutaneous cheek tumors located in the central to posterior masseteric region, while minimizing the risk of injury to the facial nerve and parotid duct, and achieving a favorable cosmetic outcome.