This is the case of a 15-year-old Kenyan girl of Kikuyu descent who presented with a diffuse, painful, slight cheek swelling on the right side of her face. The pain and swelling consistently increased in size just before and during meals. The painful area was well defined and the pain confined with no radiation. Her medical and dental histories were unremarkable except for treatment for otitis media 3 months before her presentation.
On examination her chronologic age was commensurate with her physique. The right parotid area was tender with no obvious change in the skin color. Intraorally, she had unerupted 8 s, missing 12, and a peg lateral in place of 22. The intraoral soft tissue was normal in color, texture, and consistency except around the right Stensen’s duct opening, which was inflamed. A small amount of pus was expressed from the right duct when slight pressure was applied on the papilla.
A diagnosis of acute suppurative sialadenitis was made and treatment executed in the form of copious fluid intake, amoxicillin and clavulanic acid (500 mg/12 5 mg) twice a day for 5 days, paracetamol 1000 mg three times a day for 5 days and povidone-iodine (Betadine) gargle for 7 days. The infection resolved completely until about a year later when she presented with signs and symptoms as those initially observed. A similar treatment regimen was prescribed and, after elimination of the infection, the patency of the right Stensen’s duct was checked by cannulation with no indication of obstruction.
About 2 years following her initial submission she presented with a recurrence of the initial signs and symptoms. It was immediately decided to perform a magnetic resonance imaging (MRI) scan (Fig. 1). This showed a homogenous well-defined right cheek lesion medial to the buccinator muscle and engulfing the ipsilateral Stensen’s duct. The clinical and radiographic features of the lesion were suggestive of a lipoma with the differential diagnosis of oral dermoid cyst, epidermoid cyst, and lymphoepithelial cysts considered. A decision was made to excise the lesion via an intraoral approach (Figs. 2 and 3). The Stensen’s duct was cannulated for localization and protection during the surgery. Following excision of the lesion, histopathology diagnosis confirmed a lipoma of the right cheek area. Immediately following recovery from the surgery, our patient reported complete resolution of previously noted symptoms of pain, discomfort, and swelling that were related to mealtimes. Six months following surgery, our patient is symptom-free and continues to be monitored.