The buccal fat pad flap in oral reconstruction

Gross anatomical, CT and MRI analyses of the buccal fat pad with special emphasis on volumetric variations

The use of the buccal fat pad (BFP) has increased in popularity in recent years because of its reliability, ease of harvest, and low complication rate during oral and maxillofacial procedures. The aim of this study was to evaluate the volumetric variations of the BFP with a CT and MRI, as well as the thickness, weight and volume with conventional methods. We have examined the BFP from 80 formalin fixed adult cadavers (mean age 59) derived from both males (45) and females (35). In addition, we also examined 20 cadaveric BFPs using MR and CT imaging. Digital image analysis software was used to measure the volumetric distribution and to characterize the morphology of BFP. The BFP can be divided into three lobes (anterior, intermediate, and posterior) and has four extensions (buccal, pterygoid, pterygopalatine, and temporal). The BFP is fixed by six ligaments, to the maxilla, posterior zygoma, inner and outer rim of infraorbital fissure, temporalis tendon, and buccinator membrane. The mean volume in males was 10.2 ml and ranged 7.8-11.2 ml, while in females the mean volume was 8.9 ml and ranged 7.2-10.8 ml. Additionally, the mean thickness was 6 mm, with a mean weight of 9.7 g. These facts may be important when considering the use of the BFP in reconstruction, particularly whether the correct volume has been removed from each side in aesthetic, oral, or maxillofacial procedures.

Comparison of radial forearm free flap, pedicled buccal fat pad flap and split-thickness skin graft in reconstruction of buccal mucosal defect

There are a variety of methods to reconstruct the mucosal defect after the ablation of buccal cancer. We used the radial forearm free flap (RFFF), pedicled buccal fat pad flap (PBFPF) or split-thickness skin graft (STSG) to reconstruct the buccal mucosal defect in our series respectively and compared the mouth-open width among these methods. We found there was no significant difference in the change of mouth-open width between the Group STSG and Group PBFPF. However, the negative effect on the mouth opening was significantly less (p<0.05) in Group RFFF when compared with the Group STSG or Group PBFPF. In conclusion, reconstruction with radial forearm free flap for buccal mucosal defect carries more chances to preserve the original mouth-open width than with pedicled buccal fat pad flap or split-thickness skin graft among the selected patients who undergo tumor resection for T2 or T3 buccal cancer.

Use of the buccal fat pad in the reconstruction and prosthetic rehabilitation of oncological maxillary defects

We evaluated the effectiveness of the buccal fat pad as a pedicled flap for intraoral reconstruction after partial maxillectomy for neoplastic disease in 24 patients, and subsequently, in providing support for a denture. In all patients the buccal fat pad was covered with a split-skin graft and an acrylic plate. There was complete healing of the buccal fat pad flap within 6 weeks in 18 patients with no major complications, and minimal effects on speech and eating. In six cases there was partial dehiscence of the flap, which healed spontaneously in one patient and was repaired with local flaps in two others. There were no cases of complete breakdown of the flap. Eight patients so far have been rehabilitated with small dentures. In conclusion, the buccal fat pad flap is a simple, quick, and reliable method of reconstruction of small to medium-sized posterior maxillary alveolar defects.

The buccal fad pad lined with a metabolic active dermal replacement (Dermagraft) for treatment of defects of the buccal plane

The buccal fad pad flap (BFPF) is an easy to raise pedicled flap for closure of intraoral defects with barely any donor defect. The major disadvantage of the BFPF is the missing epithelial lining, which can induce fibrous tissue formation with resulting functional impairment. To overcome this problem we lined the BFPF with a dermal replacement (Dermagraft) consisting of living metabolic active fibroblasts. In six patients, defects resulting from tumour removal were reconstructed with a combination of the BFPF and Dermagraft and followed up for at least 2 years. In all patients a defect closure was achieved with no functional impairment. The clinical character which was achieved was more a type of defect regeneration than a flap closure. The availability of bioengineered metabolic active tissue can overcome the major problem of the BFPF as an option for defect closure of the buccal side. Furthermore the regeneration of the defects optimises clinical tumour monitoring.

The buccal fat pad in oral reconstruction

We describe the indications, advantages, and complications of the buccal fat pad (BFP) flap and report our clinical experience with the flap for intraoral reconstruction after tumour removal.

METHODS

From 1993 to 2002, a pedicled BFP flap was used to reconstruct oral defects after tumour removal in 15 patients, prospectively analysed.

RESULTS

Adequate closure of the defect was achieved. In seven cases there was some retraction of the BFP.

CONCLUSIONS

The BFP, as a flap, offers a good and simple option in the reconstruction of small to medium defects in the oral cavity, above all in older patients. The greatest disadvantage is that reduction in oral opening could occur, to an unpredictable degree.

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.

Palatal rotation-advancement flap for delayed repair of oroantral fistula: a retrospective evaluation of 63 cases

OBJECTIVE

To review our 17-year clinical experience with delayed oroantral fistula repair by palatal rotation-advancement flap, and to report its advantages, disadvantages, and complications.

STUDY DESIGN

The records of 63 patients with late oroantral fistula treated by palatal rotation-advancement flap from 1984 to 2002 were reviewed. Eleven had undergone unsuccessful closure with a buccal flap. Data recorded were patient age and sex, cause of fistula, signs and symptoms, interval from appearance of fistula to repair, fistula size, radiographic appearance, method of repair, and immediate and late complications.

RESULTS

There were 35 women and 28 men aged 21 to 71 years (mean 50.3 years). Surgery was performed 3 months to 20 years after injury (mean 1.8 years). Twenty-four patients had acute maxillary sinusitis and 39 had chronic sinusitis. The main causes of oroantral fistula were extraction of the second and first molars and pathological lesions within the sinus. Average fistula size was 2.3 cm x 1.6 cm. Fifty-one repairs were preceded by Caldwell-Luc operation. All fistulas were successfully closed with the palatal rotation-advancement flap, with minimal complications on long-term follow-up.

CONCLUSION

The palatal rotation-advancement flap is recommended for the late repair of oroantral fistula owing to its good vascularization, excellent thickness and tissue bulk, and easy accessibility; it also allows for the maintenance of the vestibular-sulcus depth. It is particularly indicated in cases of unsuccessful buccal flap closure.

Reconstructive techniques for the repair of oral and maxillofacial oncological procedures: what are they, how do they work and what do they look like?

BACKGROUND

There are many different ways to reconstruct the oral and maxillofacial region post tumour ablation. In the past, the resection of oral tumours had been associated with significant disfigurement and loss of function. Modern techniques aim to restore function and improve cosmetics. This paper aims to describe the techniques used in patients treated at the Austin and Repatriation Medical Centre and to answer the more common questions associated with reconstructive techniques.

METHODS

A review of techniques of oral reconstruction used by our unit over the last nine years and a review of the literature.

RESULTS

Various techniques of reconstruction gained from our experience in treating patients with oral cancer are documented. There are a variety of techniques including grafts, local flaps, regional flaps and free vascularized flaps. Metallic implants such as osseointegrated dental implants may also be used for dental rehabilitation.

CONCLUSIONS

There are many different methods of reconstruction in patients who have had resection for oral tumours. It is important for general dental practitioners who may be involved with the care of such patients to have an understanding of the modern techniques of reconstruction that may be used.