Anatomy of the buccal fat pad and its clinical significance

Immediate reconstruction of maxilla with bone grafts supported by pedicled buccal fat pad graft

PURPOSE

To reconstruct immediately the maxilla with bone grafts after partial maxillary resection and solve complications of exposed bone grafts to the maxillary sinus leading to a high rate of bone infection and sequestration.

STUDY DESIGN

Thirty-eight patients were treated by immediate reconstruction of the maxilla with bone grafts supported by pedicled buccal fat pad (BFP) graft. The facial contour, the bone healing of the bone grafts, and the function of the maxillary sinus were evaluated with the Waters radiograph and speech evaluation.

RESULTS

The postoperative healing was satisfactory with normal mouth opening and symmetrical contour of the face. The function of the maxillary sinus was restored with satisfactory speech and symmetrical density on radiograph and the healing of the bone grafts was good without complications such as bone resorption and sequestration.

CONCLUSIONS

Immediate reconstruction of the maxilla with bone grafts supported by pedicled BFP grafts can restore the facial contour and the function of the maxillary sinus for the patients with partial maxillary resection. It provides a good method to reconstruct the maxillary defects and function in the mouth.

[The temporal periosteum: anatomical study and surgical implications]

The periosteum of the temporal area is mentioned at different places in the literature: either against the osseous plane like everywhere in the human body, or between the deep and the superficial temporal fascia. The subperiosteal subtemporal approach in craniofacial surgery in children is in favour of a juxta-osseous localization of the periosteum. Ten premature still-born neonates and two adults cadavers have been dissected for this study and, permit anatomical and histological (with HES coloration) studies. With every specimen, the authors concluded that the temporal periosteum is against the outer table of the calvarium. It became thinner in adults because of direct insertions of the temporalis muscle in the calvaria. An anatomical description of the layers of the temporal area is realised and discussed with an extensive review of the literature. The authors have proposed a subperiosteal subtemporal approach in craniostenosis surgery.

Reconstruction of Oral Defects with the Pedicled Buccal Fat Pad Flap

Pedicled buccal fat pad flaps were used to reconstruct defects produced by resection of tumors of the oral cavity in 21 patients. The indications included defects of the oral mucosa and defects after excision of a benign or malignant tumor, preferably smaller than 5 cm in diameter. The results were excellent, and there was no added morbidity. Only 1 delay failure and 1 complication were observed. The anatomy and surgical technique are described. The results suggest that these flaps are a direct, convenient, and reliable option for the reconstruction of small defects of the oral mucosa.

The use of the buccal fat pad for reconstruction of oral defects: review of the literature and report of 15 cases

PURPOSE

Although the buccal fat pad (BFP) was originally used as an alternative method for the closure of small to medium-sized oroantral and oronasal communications, its use has now been extended to use after excision of oral malignancies. This report describes experience with this technique.

PATIENTS AND METHODS

The BFP was used as a pedicled graft to reconstruct medium-sized surgical defects of the oral soft and hard tissues in 15 patients suffering from oral malignant tumors. Six of the defects were in the maxilla, 3 in the retromandibular area, and 6 in the cheek and oral commissure. The BFP was left uncovered to epithelialize in 14 patients, and in one it was covered with lyophilized dura.

RESULTS

The BFP healed without complications within 3 to 4 weeks in 13 patients, whereas in 2 patients with maxillary defects there was partial loss of the graft, requiring the additional use of an obturator in 1 case and a tongue flap in another to prevent oronasal leakage. Harvesting the graft proved to be extremely easy, and care was only necessary to avoid severing the supporting vascular plexus and the thin capsule covering the BFP.

CONCLUSIONS

The findings support the view that the BFP is a useful, easy, and uncomplicated alternative method for the reconstruction of small to medium-sized surgical defects of the oral hard and soft tissues.

The anatomy of midfacial ptosis

PURPOSE

To investigate the anatomic and histologic changes present in midfacial ptosis.

METHODS

Experimental study applying gross anatomic and histologic techniques to formalin-preserved and fresh-frozen cadaver heads with and without midfacial ptosis. High-resolution surface coil magnetic resonance imaging (MRI) was performed to obtain radiologic correlations.

RESULTS

The orbitomalar ligament was further characterized by identification of a well-developed lateral component in the sub-superficial musculoaponeurotic plane; abnormalities of this important supporting structure were present in the subcutaneous plane in 8 of 10 specimens with midfacial ptosis. The zygomatic and masseteric cutaneous ligaments also were further characterized on a gross anatomic level, and histologic evidence of these two structures was produced. The subcutaneous components of the zygomatic and masseteric cutaneous ligaments were attenuated or not identifiable in 40% and 30% of specimens with midfacial ptosis, respectively. High-resolution surface coil MRI provided exquisite correlations of midfacial anatomy.

CONCLUSIONS

The lateral component of the orbitomalar ligament provides major osteocutaneous midfacial support. Subcutaneous attenuation of the orbitomalar, masseteric cutaneous, and zygomatic ligaments was associated with midfacial ptosis.

Use of buccal fat pad to repair intraoral defects: review of 30 cases

The buccal fat pad has been frequently used for the closure of oro-antral and oro-nasal communications. There are a few studies in the literature reporting its use in defects secondary to tumoral resections. In this paper we consider both the anatomical basis and the surgical technique. We also review 30 cases, used for the repair of 15 defects due to tumoral resections, 8 to maxillary cysts, 6 to communications and 1 secondary to a postraumatic defect. It has been successful in 28 of the 29 patients, with a complete epithelization of the flap, even in 4 cases with partial necrosis of the pad. It is an acceptable type of reconstruction, versatile and of a simple surgical technique. However, its use is limited to small or medium defects, being sometimes scarce.

Application of the buccal fat pad to the surgical treatment of oral submucous fibrosis

The pedicled buccal fat pad has been widely used for the repair of oral defects. A new application of this flap in the treatment of patients suffering from trismus caused by oral submucous fibrosis is reported. The patients underwent incision of the fibrotic bands and coverage of the buccal defect with a pedicled buccal fat pad flap. The surgical technique is described, and the results suggest that this is a logical, convenient, and reliable technique for the treatment of oral submucous fibrosis.

The arterial anatomy of the temporal region and the vascular basis of various temporal flaps

The arterial anatomy of the temporal region was examined macroscopically and radiographically in 10 fresh cadavers which had been injected with lead oxide. The blood supply of the temporal region is derived from the superficial temporal, middle temporal, deep temporal, posterior auricular, transverse facial, zygomatico-orbital, zygomaticotemporal, zygomaticofacial, and middle meningeal arteries. The vascular network formed by these arteries can be divided into four arterial networks corresponding to the different layers of the temporal region. With a new understanding of the arterial networks and their anastomoses, the techniques for elevating various flaps in the temporal region are discussed.

Closure of oroantral communications using a pedicled buccal fat pad graft

PURPOSE

This report evaluates the use of a pedicled buccal fat pad graft for closure of oroantral fistulae.

MATERIALS AND METHODS

Fourteen patients with oroantral communications, ranging from 8 to 20 mm in diameter, were treated by the use of a pedicled buccal fat pad graft.

RESULTS

The procedure was successful in 13 of 14 patients. Postoperatively, the orally exposed fat gradually was transformed into a granulation-like tissue and epithelization developed within 3 weeks.

CONCLUSION

It was concluded that the procedure has wide application and a high degree of success.

Anatomy and significance of the temporal fat pad in Apert syndrome

Abnormal temporal region anatomy in Apert syndrome described in the literature includes inferior and lateral displacement of the middle cranial fossa, effacement of the temporal fossa, and thinning of the temporalis muscle. Four patients with Apert syndrome were noted to have hyperplasia of the bilateral superficial temporal fat pads, which could be contoured surgically. A case is presented with reformatted three-dimensional computed tomography (3-D CT) scans with intraoperative documentation of increased temporal fat as compared to normal controls.

Sculpturing the broad face to ‘golden proportions’

The oval shaped face is generally accepted as having the most beautiful configuration and the ‘golden proportion’ (1:1.618) ideal. Such a configuration can be altered to a square or rectangular shape by an increase in width of the lower face. This broadened morphology can be caused by three anatomical elements: hypertrophy of the masseter muscles, hypertrophy and flaring of the mandibular angles, and hypertrophy or herniation of the buccal fat pads of Bichat. The first two anatomical structures can occasionally become enlarged through work hypertrophy related to malocclusion or dental disease, and the latter displaced through traumatic herniation. Each of these contributing anatomical anomalies can be reduced in size by a single intraoral operative procedure with minimal risk to achieve an aesthetically pleasing oval shaped configuration to the face. There are very few hazards to this procedure and the results are routinely satisfying to both the patient and the surgeon.

The buccal fat pad in oral reconstruction

The use of the buccal fat pad (BFP) as an uncovered pedicled graft to close oral defects is relatively recent. A series of 29 consecutive cases of reconstruction utilizing the BFP is presented, showing excellent results and without added surgical morbidity. Indications include defects after benign or malignant tumour resection, and the combined BFP/temporalis myofascial pedicled flap is reported as an additional option in reconstruction. Histologic findings in healed reconstruction sites indicate fibrous replacement of the fat tissue, and epithelialization of its oral surface. From the results of this series, we conclude that the use of the BFP for the reconstruction of appropriate surgical defects in the mouth is worthy of consideration.