The exclamation mark at the beginning of the post is warranted! I have written before about the God's scheming to keep surgeon's on their toes by making sure the intra operative findings completely differ from the initial clinical assesment as was the case during the mysterious hernia here.. I'm quite prepared to give this phenomenon a name maybe Techknowdoc's Law (on the lines of Murphy!)
A 40 something Koli (fisherfolk community) woman presented to us with a swelling over her left buccal surface not visible from the outside but fairly big on the inside. It was bothering her as it would interfere with her eating and brushing. Now that I have mentioned brushing, this lady would not use toothpaste but tobacco powder (an unfortunate but very common occurrence in rural India)
This simple piece of information was enough to make us suspicious and we did the usual palpations and tests.An ultrasound exam revealed an echopoor mass with some solid component and no conclusion was offered by the radiologist on the first exam. She also turned out to be hypothyroid which prompted us to think in terms of an aberrant thyroid mass (lingual thyroid is common too)
She was advised an MRI and a thyroid uptake scan both of which were not done as she was not in a position to afford expensive tests. A repeat ultrasound after 2 weeks showed that the mass was not shrinking after a course of antibiotics, and the neck scan revealed normal thyroid tissue and a reactive lymph node on the opposite side.
She was getting very restless and offered a blanket consent for removal. We decided to go ahead and operate. After preop preperations were complete, she was taken in the OT and was given local anaesthesia with an anaesthetist standby. As soon as we took the incision, a grand yellow soft mass popped out.
Once again, the infamous Lipoma (which has baffled us before - as seen in this post) had surfaced in the most unlikely of locations with the most unusual presentation. This was easily removed and the patient was sent home about 2 hours post the surgery! She walked in for a follow up after a week with the mouth wound completely healed and the histopathology report confirming a simple Lipoma.
I guess the God's were giving us a break with this fortunate happy ending! This case will be prepared as a case report and sent to a medical journal for publication. Hopefully, it should end up published.