Subperiosteal Excision of a Fibrolipoma in the Mandibular Alveolar Region Near the Mental Foramen: A Case Report.

Fibrolipomas of the oral cavity are uncommon, and occurrence in the mandibular alveolar mucosa adjacent to the mental foramen is particularly rare. We report a 68-year-old woman who presented with a painless swelling of the right lower gingiva. Clinical and radiologic evaluation identified a well-circumscribed lipomatous lesion located 3 mm anterior to the right mental foramen. Computed tomography (CT) demonstrated a homogeneous low-density mass, and magnetic resonance imaging (MRI) showed high signal intensity on T1- and T2-weighted sequences with signal suppression on short Tau inversion recovery (STIR), findings consistent with a lipomatous tumor. Given the lesion's close relationship to the mental neurovascular bundle, complete excision was performed via a subperiosteal approach to preserve the overlying mucosa and minimize risk to sensory function. Under local anesthesia, a triangular mucoperiosteal flap was elevated, and the tumor was removed en bloc. Intraoperatively, no adhesion to the mental nerve was observed. Histopathology revealed mature adipocytes embedded in a dense fibrous stroma, confirming the diagnosis of fibrolipoma. The postoperative course was uneventful, with no sensory deficits or recurrence during follow-up. This case underscores two clinical points. First, fibrolipoma in this location is rare and requires thorough imaging to distinguish it from other submucosal masses. Second, a subperiosteal approach permits complete resection while maintaining mucosal integrity and protecting adjacent neurovascular structures, thereby reducing postoperative morbidity. Our experience reinforces the importance of tailoring surgical strategy to the lesion's anatomy in intraoral lipomatous tumors.