A 24-month-old Indian girl presented to the emergency room with a protruding intraoral lesion. The traumatic event was not eye-witnessed. Her mother suspects her daughter to have fallen while playing with a wooden ice cream stick in her hand the night before. As per the parents, a protruding mass was found in the left oral cavity with minimal bleeding and mild facial edema immediately after the accident.
On clinical examination, approximately 14 hours from the time of the accident, the child was noted to have a large, smooth mass protruding from the left buccal mucosa which was blood-tinged yellow in color. The parents denied any evidence of color change since the night before. Typically, oral laceration was minimal and bleeding was absent. The mass was noted to change its size during the examination with the jaw movements of the child.(Fig. 1)
At this time the pedunculated lesion was suspected to be a portion of the buccal fat pad. However, a detailed examination was not possible at this time as the child was unable to cooperate with the examination. Her mother reported providing daily oral care and denied the presence of any lesion before this event. Past medical history and latest laboratory investigations were unremarkable. After appropriate investigations and obtaining informed consent, the patient was taken up for examination and necessary intervention under general anesthesia.
In the operating room, she was noted to have an approximately 3 × 1.5-cm pedunculated mass protruding from the left buccal mucosa approximately 5mm posteroinferior to the orifice of the Stenson’s duct. The left parotid duct expressed clear saliva without any difficulty. The clinical picture (Fig. 2) indicated that the mass was the buccal fat pad due to its smooth surface texture and peculiar anatomic position. This mass had herniated intraorally due to the tear in the parotidomasseteric fascia and buccinator muscle. As there was no sign of necrosis or fibrosis or tear of the capsule it was decided to reposition it despite its size. During its surgical intervention, the protruding buccal fat pad was thoroughly cleansed with saline and gently pushed to its normal anatomic position through the existing defect The laceration was thoroughly irrigated and closed with 3 − 0 polyglactin 910 (Vicryl) in a simple interrupted fashion. Utmost care was taken during the procedure to prevent injury to the Stenson’s duct. (Fig. 3)
In our case, the repositioning was done approximately 16 hours after the injury. Our patient was monitored indoors for 48 hours after the procedure. Intravenous antibiotics and analgesics were administered by the pediatric team for the 3 days. There was evidence of post-surgical facial edema for 3 days. The patient was discharged and recalled once a week for 2 weeks. Intraoral mucosal healing was uneventful and facial symmetry was restored. No complications have been noted after 6 months.