A review of the gross anatomy, functions, pathology, and clinical uses of the buccal fat pad

Safe Zones for Facial Fillers: Anatomical Study of SubSMAS Spaces in Asians

The study "Spaces of the Face for Filler Procedures: Identification of subSMAS Spaces Based on Anatomical Study" explores the anatomy of facial spaces crucial for safe and effective filler injections. By delineating the subSMAS (sub-superficial musculoaponeurotic system) spaces, this research highlights how these virtual compartments, bordered by fat, muscles, fascia, and ligaments, facilitate independent muscle movement and reduce the risk of damaging critical structures. The thicker and more robust skin of East Asians necessitates deeper filler injections, emphasizing the significance of accurately identifying these spaces. A cadaver study with dyed gelatin validated the existence and characteristics of these subSMAS spaces, confirming their safety for filler procedures. Key spaces, such as the subgalea-frontalis, interfascial and temporalis, and prezygomatic spaces, were examined, illustrating safe zones for injections. The findings underscore the importance of anatomical knowledge for enhancing facial aesthetics while minimizing complications. This study serves as a guide for clinicians to perform precise and safe filler injections, providing a foundation for further research on the dynamic interactions of these spaces and long-term outcomes.

A Review of the Use of Buccal Fat Pad in Cleft Palate Repair

OBJECTIVE

To review the available evidence on the use of the Buccal Fat Pad in primary and secondary Cleft Palate repair.

METHODS

This is a narrative review. A computerized literature search was conducted for articles published till February 2022 using the Mesh phrases buccal fat pad AND cleft palate, Bichat's Fat pad AND cleft palate, buccal fat pad OR Bichats Fat pad AND cleft palate.

RESULTS

A total of 35 articles were included in this review based on the set eligibility criteria. Most of the studies were retrospective case reviews (n  =  16, 45.7%), and the aggregate number of patients from all included studies was 666. Reported uses of the buccal fat pad (BFP) in association with cleft palate repair include the closure of central cleft palate defect and nasal floor in primary cleft palate repair, oronasal fistula repair following primary repair of cleft palate, and closure of relieving incision defect in primary repair of cleft palate. Complications reported were 24 cases of Oronasal Fistula (ONF), 2 dehiscences, and 4 transient mucosal defects.

CONCLUSION

The high success rate, vascularity, ease of tissue harvest, and low donor site morbidity all support its use as an adjunct flap in cleft palate repair, especially in the closure of wide palatal clefts, to prevent post-palatal repair fistula, wound contracture, and subsequently velopharyngeal insufficiency and possibly midface hypoplasia.

Frequency of MRI Low Signal Intensity in the Buccal Fat of Fetuses and Speculation as to What It May Reflect

PURPOSE

We aimed to characterize the fetal buccal fat pad (BFP) on magnetic resonance imaging (MRI) to determine the frequency and types of sequences on which the BFP demonstrates low signal intensity and determine any possible correlation with timing of the MRI during fetal development.

MATERIALS AND METHODS

A retrospective review of all fetal MR studies was performed, and a pediatric radiologist blinded to the referring and final fetal diagnosis as well as outcome evaluated the included cases. A positive buccal fat pad sign (BFS) was recorded as present if a round, symmetric, and bilateral area was seen in the submalar region of the face with the following signal characteristics: T1 hyperintensity, low signal on echo planar imaging (EPI), low signal on true fast imaging with steady-state free precession (TRUFI), and with restriction on diffusion-weighted imaging (DWI).

RESULTS

A total of one hundred sixty-seven (167) fetal MRI studies: one hundred fourteen (114) body (68%) and fifty-three (53) neuro (32%) scans were reviewed during the study period. The BFS was most commonly seen on EPI (63%) and TRUFI (49%) sequences. Substantial agreement between TRUFI and EPI (κ = 0.68; p < 0.01); moderate agreement between TRUFI and T1 (κ = 0.53; p < 0.01) as well as T1 and EPI (κ = 0.53; p < 0.01), and fair agreement between EPI and Diffusion (κ = 0.28; p < 0.01) was observed. The median gestational age (GA) was 24 weeks (IQR 22-30 weeks). The fetuses with a positive BFS were significantly older (mean GA of 27 weeks or higher) than those without, for each sequence.

CONCLUSIONS

The focal low signal in the fetal buccal fat pad, termed the fetal BFS, is a commonly encountered normal finding in the majority of fetal MRI scans on TRUFI and EPI sequences. This finding may be related to the presence and development of brown adipose tissue in the buccal fat pad resulting in T2* effects, but further studies are needed in order to confirm this. Further work can incorporate any of the sensitive sequences demonstrating low signal in brown adipose tissue to map its distribution and development in the fetus and beyond.

The Buccal Fat Pad as a Primary Flap for the Reconstruction of Intraoral Defect After Resection of Oral Cavity Malignant Tumors: A Retrospective Study

BACKGROUND

Among the various local and regional flaps used for the reconstruction of intraoral defects after oral cavity cancer surgery, the pedicled buccal fat pad (BFP) flap is considered a reliable alternative. Reconstruction with a BFP flap is particularly feasible in oral cavity areas, such as the posterior maxilla, buccal mucosa, retromolar trigone, and gingivobuccal sulcus. The purpose of this study was to analyze the outcomes of pedicled BFP as a primary reconstruction flap for small to medium intraoral posterior oral cavity postresection defects operated in our institute.

METHODS

This study was designed as a retrospective study. Thirty-seven patients with oral cavity cancer underwent wide local excision with adequate margins, followed by reconstruction of the defect with a pedicled BFP flap. Defect size, postoperative healing of the surgical site, mouth opening at 6 months, and any associated complications were assessed.

RESULTS

The mean age of the patients was 47.38±9.95 years with a male-to-female ratio of 3.6:1. Mean defect size at the greatest dimension was 5.01±1.39 cm. The mean preoperative mouth opening of patients was 35±6.4 mm, whereas the mean postoperative mouth opening after 6 months of follow-up was 27.8±9.2 cm.

CONCLUSION

The BFP flap is a convenient, reliable, and feasible reconstruction modality after oncological resection of posterior oral cavity cancers. Harvesting a BFP flap is minimally invasive with fewer complications, shorter recovery time, no donor site morbidity, and allows early initiation of adjuvant therapy postoperatively.

Buccal Fat Pad Excision for Facial Rejuvenation: The Relationship Between the Resected Position and Its Influence on Facial Shape and Volume

Background

To date, facelift surgery has been the most common choice for those seeking antiaging solutions. However, buccal fat pad (BFP) excision has also been utilized recently.

Objectives

An interrelation between the BFP, resection area, and its influence on facial shape and volume is scrutinized to achieve "tailor-made" outcomes in patients with BFP-related symptoms.

Methods

Patients were categorized into 2 groups: Type I with a bottom-heavy face and Type II with ptotic lower cheeks, typically seen in older people. The lower face was divided into upper and lower segments bilaterally. Then, the relationship between the resected position of the BFP and its influence on facial shape and volume was studied.

Results

BFP excision was performed for 133 patients (118 females and15 males) between May 2020 and June 2022. Sixty-one of these patients were categorized into Type I (39 patients) and Type II (22 patients) and were followed up for 12 months postoperatively. The volume of all lower facial segments decreased postoperatively in both types of patients. The variation rate of the upper segment volume in Type II patients was less than that in Type I patients. The results were consistent with a technique that did not remove large chunks of the BFP from the upper segment in Type II patients.

Conclusions

BFP excision is an effective facial rejuvenation treatment if proper candidates are selected. To improve the accuracy of BFP excision, the relationship between the resected position of the BFP and its influence on facial shape and volume should be well understood.

Level of Evidence 3

Clinical features of tumours and tumour-like pathologies involving the buccal fat pad

This study aimed to investigate the clinical, radiological, and pathological characteristics of pathologies involving the buccal fat pad (BFP) and to explore the treatment protocols. The cases of 109 patients with primary pathologies involving the BFP (pBFP) diagnosed between January 2013 and September 2021 were assessed. The patients' clinical presentations and radiological and histopathological findings were analysed retrospectively, and their treatment outcomes were evaluated. The 109 pBFP were categorized as benign tumours (n = 17), malignant tumours (n = 29), vascular malformations (n = 38), and inflammatory masses (n = 25). Of the 17 benign tumours, seven were lipomas, five were pleomorphic adenomas, three were solitary fibrous tumours, and two were other tumours. The 29 malignant tumours included five adenoid cystic carcinomas, six mucoepidermoid carcinomas, three synovial sarcomas, and 15 other tumours. Of the 38 vascular malformations, 37 were venous and one was arteriovenous. Regarding the inflammatory masses, the lesions appeared after cosmetic facial botulinum toxin injection in 13 cases and after other cosmetic facial procedures in five. The upper body of the BFP was the most frequently involved site (79/109), while other frequently involved sites were the lower body (67/109) and the masseteric (41/109), temporal (32/109), and pterygopalatine (30/109) extensions.

Bitemporal Obesity: An Overlooked Sign of Visceral Obesity?

With increasing rates of morbidity and mortality associated with visceral obesity, as well as its related cardiometabolic disorders, physical findings that aid in diagnosing patients at risk for such conditions are extremely useful. This brief report introduces the novel facial physical sign of bitemporal obesity, which the author observed in a patient and suggests to be associated with visceral obesity.

Fat Grafting: Basic Science, Techniques, and Patient Management

In this review, a summary of the rich history of autologous fat grafting is provided, and a comprehensive summary of the science and theory behind autologous adipocyte transplantation, as well as the techniques commonly used is described. These include recipient site preparation, harvesting, processing, and engraftment. In addition, important considerations for preoperative and postoperative management are discussed to maximize graft retention. Special considerations in grafting to the breast, face, and buttocks are also summarized.

Buccal fat pad excision for cheek refinement: A systematic review

BACKGROUND

Buccal Fat Pad (BFP) excision has become an aesthetic surgical procedure. Although this procedure is quite common, it is important to bear in mind that the scientific evidence supporting the efficacy of this treatment is scarce and of low quality. The purpose of this systematic review was to analyse all relevant data to assess the efficacy and safety of BFP excision for improving midface aesthetics.

MATERIAL AND METHODS

A thorough search of MEDLINE (PubMed), Scopus and Cochrane Library databases was conducted. The PICO approach was used where healthy patients seeking cheek slimming and facial silhouette refining undergo BFP excision and were compared before and after surgery in terms of BFP volume reduction, adverse effects and patient satisfaction.

RESULTS

Of the 1,413 references identified, 4 were included in the qualitative synthesis. Only one study reported BFP volume reduction, which was 3.10 mL (95%CI: 2.38 to 3.80; P < 0.001), and the mean volume of the excised tissue was 2.74 ± 0.69 mL (range, 1.8-4.9 mL). 84.6% of the patients stated that their facial contour was much better and the remaining 15.4% noticed that the appearance of their cheeks following BFP excision was better. Seven complications were reported in the 134 cheek refinement procedures.

CONCLUSIONS

BFP removal has an initially favorable outcome for facial aesthetics and a low postoperative complication rate, however, there are many procedures being performed with poor quality methodology and there is also a lack of published data on its long-term follow-up results.

External Approach to Buccal Fat Excision in Facelift: Anatomy and Technique

BACKGROUND

Masculinization of the face is a common finding in facelift patients. It is attributed to deflation and decent of the midface-jowls coupled with skin laxity. Fullness is evident lateral to the jowl in a small percentage due to prominent buccal fat pad (BFP).

OBJECTIVES

The authors sought to examine the anatomy of the BFP, triangulate the prominent BFP with surgical landmarks, and describe an external approach to excise the BFP during facelift surgery.

METHODS

Eighteen cadaveric dissections were performed. Facelift flap was elevated and the prominent buccal extension of the BFP protruding through the superficial-musculo-aponeurotic-system was identified. Measurements were taken from the BFP to surgical landmarks: zygomatic arch, tragus, and gonial angle. The locations of the facial nerve, parotid duct, and vascular pedicle relative to the BFP were calculated.

RESULTS

BFP was 4.1 cm inferior to the zygomatic arch, 7.5 cm anterior the tragus, and 4.5 cm medial the gonial angle. The middle facial artery supplied the BFP on the inferior-lateral quadrant in 61% and inferior-medial quadrant in 39% of specimens . In all specimens, the parotid duct traversed the BFP superiorly, and the buccal branches of the facial nerve traversed the capsule superficially.

CONCLUSIONS

The buccal extension of the BFP can pseudoherniate in the aging face. Excision may improve lower facial contour. Measurements from facial landmarks may help surgeons identify the buccal extension of the BFP intraoperatively. The surgeon must be careful of the vascular pedicle, parotid duct, and the facial nerve. The external approach safely excises buccal fat during facelift dissection while avoiding intraoral incisions and unnecessary contamination.

LEVEL OF EVIDENCE: 4

The Buccal Fat Pad Flap

This article presents an overview of the history of the buccal fat pad flap, its relevant anatomy, and its indications and contraindications. The surgical technique for its harvest is described, as are the postoperative care and possible complications.

A Cadaveric Study of the Buccal Fat Pad: Implications for Closure of Palatal Fistulae and Donor-Site Morbidity

BACKGROUND

For the cleft surgeon, palatal fistulae after cleft palate repair remain a difficult problem, with a paucity of local tissue options to aid closure. Small clinical series have described the use of the buccal fat pad flap to repair palatal fistulae; however, there is no literature detailing the anatomical coverage of the flap. This study delineates the anatomy of the buccal fat pad flap to guide surgeons in patient selection and examines the residual buccal fat after flap harvest to provide new information with regard to possible effects on the donor site.

METHODS

Buccal fat pad flaps were raised in 30 hemicadavers. The reach of the flap across the midline, anteriorly and posteriorly, was recorded. In 18 hemicadavers, the entire buccal fat pad was then exposed to determine the effects of flap harvest on movement and volume of the residual fat.

RESULTS

All buccal fat pad flaps provided coverage from the soft palate to the posterior third of the hard palate and all across the midline. Approximately three-fourths of flaps would cover the mid hard palate. The flap constitutes 36 percent of the total buccal fat pad on average, and a series of retaining ligaments were identified that may prevent overresection.

CONCLUSIONS

The buccal fat pad flap is a useful tool for coverage of fistulae in the soft palate to the posterior third of the hard palate. In most cases, it will also reach the middle third; however, it is not suitable for more anterior defects. On average, two-thirds of the buccal fat pad remains within the cheek after flap harvest, which may protect against unwanted alteration in aesthetics.

Identification of distinct transcriptome signatures of human adipose tissue from fifteen depots

The functional and metabolic characteristics of specific adipose tissue (AT) depots seem to be determined by intrinsic mechanisms. We performed a comprehensive transcriptome profiling of human AT from distinct fat depots to unravel their unique features potentially explaining molecular mechanisms underlying AT distribution and their contribution to health and disease. Post-mortem AT samples of five body donors from 15 anatomical locations were collected. Global mRNA expression was measured by Illumina® Human HT-12 v4 Expression BeadChips. Data were validated using qPCR and Western Blot in a subset of ATs from seven additional body donors. Buccal and heel AT clearly separated from the “classical” subcutaneous AT depots, and perirenal and epicardial AT were distinct from visceral depots. Gene-set enrichment analyses pointed to an inflammatory environment and insulin resistance particularly in the carotid sheath AT depot. Moreover, the epicardial fat transcriptome was enriched for genes involved in extracellular matrix remodeling, inflammation, immune signaling, coagulation, thrombosis, beigeing, and apoptosis. Interestingly, a striking downregulation of the expression of leptin receptor was found in AT from heel compared with all other AT depots. The distinct gene expression patterns are likely to define fat depot specific AT functions in metabolism, energy storage, immunity, body insulation or as cushions. Improved knowledge of the gene expression profiles of various fat depots may strongly benefit studies aimed at better understanding of the genetics and the pathophysiology of obesity and adverse body fat composition.

Multi-modal treatment strategy for achieving an aesthetic lower face

BACKGROUND

Most women consider an oval-shaped face to be youthful and beautiful. In recent years, demand has grown for surgical procedures with a shorter downtime and fewer complications. These minimally invasive procedures include botulinum toxin type A (BoNTA) injection, filler injection, suction-assisted liposuction (SAL), laser-assisted lipolysis (LAL), thread lifting, and fat grafting. This study aims to introduce an effective method for creating an aesthetically pleasing lower face using a combination of minimally invasive procedures.

METHODS

From March 2017 to March 2019, 94 patients simultaneously underwent LAL, SAL, and thread lifting. Ancillary procedures such as BoNTA injections, hyaluronic acid filler injections, and removal of the buccal fat pad (BFP) were selectively performed according to the patient's condition.

RESULTS

Patients rated their postoperative satisfaction as very satisfied, satisfied, dissatisfied, or very dissatisfied. Approximately 83% of all respondents were satisfied with the results, whereas the remaining respondents had complaints regarding the outcomes. The most common reasons for dissatisfaction were a longer-than-expected recovery time and undercorrection, and the most severe complaint was skin depression as a result of overcorrection.

CONCLUSIONS

Our method of simultaneously performing LAL, SAL, and thread lifting, while adding BoNTA, filler injections, and BFP removal as needed, was capable of producing consistent and reliable aesthetic outcomes for the lower face.

Superficial and Deep Facial Anatomy and Its Implications for Rhytidectomy

The relationship of the skin, the superficial and deep fat compartments, and the ligaments that connect these structures is key to performing any rhytidectomy. In order to successfully mobilize, elevate, and reposition the facial soft tissues, a detailed understanding of facial anatomy is required. This article details the anatomy of the midface and neck that is essential to understanding and performing the face-lift operation.

Platelet-rich plasma counteracts detrimental effect of high-glucose concentrations on mesenchymal stem cells from Bichat fat pad

Diabetic patients display increased risk of periodontitis and failure in bone augmentation procedures. Mesenchymal stem cells (MSCs) and platelet-rich plasma (PRP) represent a relevant advantage in tissue repair process and regenerative medicine. We isolated MSCs from Bichat's buccal fat pad (BFP) and measured the effects of glucose and PRP on cell number and osteogenic differentiation potential. Cells were cultured in the presence of 5.5-mM glucose (low glucose [LG]) or 25-mM glucose (high glucose [HG]). BFP-MSC number was significantly lower when cells were cultured in HG compared with those in LG. Following osteogenic differentiation procedures, calcium accumulation, alkaline phosphatase activity, and expression of osteogenic markers were significantly lower in HG compared with LG. Exposure of BFP-MSC to PRP significantly increased cell number and osteogenic differentiation potential, reaching comparable levels in LG and in HG. Thus, high-glucose concentrations impair BFP-MSC growth and osteogenic differentiation. However, these detrimental effects are largely counteracted by PRP.

Does 3D volumetric analysis predict the reach of endoscopically harvested buccal fat pad flap

OBJECTIVES

To determine if the volume of buccal fat, ascertained by computed tomography (CT) scanning, would correspond to surface area and reach (length and width) of the flap intraoperatively to aid in the reconstruction of selected skull base defects.

METHODS

Cadaveric study of five specimens, 10 sides. Methods CT imaging and evaluation using the Osirix 9 software (Pixmeo; Bernex, Switzerland). of cadaveric heads to calculate the volume of the buccal fat bilaterally. The flap was then harvested endoscopically. Measurements were taken. Two heads were also dissected via a transfacial approach.

RESULTS

The volume of the buccal fat pad (BFP) as well as the maximum length and width of the endoscopically harvested flap were documented. There was a positive correlation shown between the calculated volume of the BFP based on CT imaging and the dissected length and width of the flap (Pearson correlation, r = 0.83 and r = 0.80, respectively). The transfacial dissection demonstrated the lobes of the BFP well, showing that most of the endoscopic mobilization of the BFP was limited to the posterior lobe, in particular to the temporalis and pterygoid components, with minimal displacement of the superficial components. This minimized the risk of visibly hollowing the buccal fullness.

CONCLUSION

Preoperative calculation of the CT-based volume of the BFP correlates positively with the intraoperative maximum reach of the flap for both length and width. Whereas the volume may be lower in some instances, the BFP would still have adequate reach to provide coverage for the lower and mid-clival region in most patients.

LEVEL OF EVIDENCE

NA. Laryngoscope, 130:1670-1673, 2020.

Buccal Fat Pad Excision: Hydrodissection Technique

BACKGROUND

Buccal fat pad (BFP) excision is a procedure in which the fat pad is extracted in order to achieve a more youthful appearance.

OBJECTIVES

The aim of this study was to describe an alternative technique that utilizes hydrodissection to extract the BFP.

METHODS

This is a controlled, prospective, randomized clinical study involving 2 groups. Group A (n = 27) underwent BFP excision with hydrodissection, during which 15 mL of a vasoconstricting anesthetic solution was injected into the BFP. Group B (n = 27) underwent BFP excision, during which 3 mL of lidocaine 2% with epinephrine was injected. All procedures were performed by the same surgeon. Variables analyzed were surgical time, intraoperative bleeding, and postoperative pain directly following surgery 2 hours after the procedure, as well as maximum pain within 72 hours of surgery and complications. Postoperative care was standardized, and patient follow-up extended over a 6-month period.

RESULTS

Pain scores for 54 patients were recorded on a visual analog scale (0-10). Mean ± standard deviation transoperative pain scores were 0.5 ± 0.8 for Group A and 1.3 ± 1.3 for Group B (P = 0.01); 2 hours postoperation the scores were 1.2 ± 0.7 for Group A and 2.6 ± 1 for Group B (P < 0.0001). Maximum pain occurred within 72 hours, and scored 1.6 ± 0.6 for Group A and 3.1 ± 1 for Group B (P < 0.0001). Mean operative time was 8:18 ± 0:47 minutes for Group A and 14:08 ± 2:28 minutes for Group B (P < 0.0001). There was a positive correlation between operative time and pain. Overall, 5.5% of patients suffered postoperative complications.

CONCLUSIONS

BFP excision by hydrodissection is an effective procedure that decreases surgical times by facilitating extraction of the BFP with less manipulation, thereby resulting in decreased postoperative pain and a more tolerable recovery.

LEVEL OF EVIDENCE: 2

Bilateral buccal space lipoma: A rare case presentation

Background

The lipoma of the oral cavity is a relatively rare pathology, characterized by overgrowth of the mature adipocytes. Buccal fat pad lipomas usually interfere with the esthetics and the function of the face.

Case Report

A sixteen-year-old patient reported slow-growing swelling, which started two years ago. Clinical examination revealed two bilateral masses in the soft tissue. MRI imaging revealed a characteristic image of bilateral lipomas connected to the buccal fat pad. Surgical removal was conducted and the histology report confirmed our clinical diagnosis of common lipoma.

Discussion

The lipoma of the buccal fat pad is a benign neoplasm of the adipose tissue. It should be removed when functional or esthetic problems occur and emphasis should be put on the correct surgical technique.

Conclusions

The bilateral buccal fat pad lipoma is an extremely rare condition of the oral cavity. Surgical removal with intraoral approach is the preferable treatment, together with intense care of the anatomical structures of the buccal space. Key words:Buccal space lipoma, oral cavity, buccal space, bilateral, buccal fat pad lipoma.

The Use of Acellular Dermal Matrix in Combination With Pedicled Buccal Fat Pad in Wide Cleft Palate Repair: A Case Report and Literature Review

We describe a case of the combined use of acellular dermal matrix and pedicled buccal fat pad (BFP) in a wide U-shaped cleft palate repair. Acellular dermal matrix was used as a "patch" repair for the nasal mucosa defect as opposed to the conventional inlay graft. The advantages include reduced cost and a smaller avascular graft load. Lateral relaxing incisions were made to ensure tension-free closure of oromucosa at midline. Lateral oromucosa defect closure with well-vascularized pedicled BFP ensures enhanced healing, less palatal contracture and shortening, and reduced infection. The palate healed with mucosalization at 2 weeks, and no complications were noted at 6 months follow-up.

The Excision of the Buccal Fat Pad for Cheek Refinement: Volumetric Considerations

BACKGROUND

Although the excision of the buccal fat pad has become very popular for achieving a slimmer midface, not all patients are good candidates for this procedure. Unfortunately, studies that provide guidelines by emphasizing volumetric and technical details are limited.

OBJECTIVES

The study compared preoperative and postoperative volumetric data to identify the amount of tissue that can safely be removed and important technical concepts involved in lower cheek contouring with buccal fat pad excision.

METHODS

Patients complaining of cheek fullness were evaluated to determine if they were good candidates for the procedure. Eligible patients were screened with transbuccal ultrasound to determine tissue volumes and anatomical details. Intraoperative and postoperative, 6th-month volume measurements were undertaken and residual tissues and vascular pedicles reevaluated.

RESULTS

Ultrasound imaging showed that the mean preoperative volume of the fat pads was 11.67 ± 1.44 mL, and the mean postoperative volume was 8.58 ± 1.07 mL. The mean volume of the excised tissues was 2.74 ± 0.69 mL. Postoperative buccal fat pad volume values correlated with the reported average in the literature for the same age group.

CONCLUSIONS

Buccal fat pad removal is an effective technique for refining the facial silhouette that should be reserved for patients with increased buccal fat pad volume. Removal of only the excessive portion of the fat pad is important because this structure provides significant volume in the midface that can be difficult to restore once aging affects the surrounding soft and bony tissue.

LEVEL OF EVIDENCE: 4

Surgical management of oral submucous fibrosis using buccal fat pad: a retrospective study of 30 cases

The aim of our study was to evaluate the effectiveness of buccal fat pad (BFP) in the management of oral submucous fibrosis (OSMF). Retrospective records of 30 patients of OSMF treated with BFP with atleast a year of follow-up were analyzed. Patients were divided into groups based on the stages of OSMF. Surgical management consisted of resection of fibrous bands, bilateral temporalis myotomy, and coronoidectomy followed by grafting with BFP. There were 17 patients of stage III (mouth opening 16-25 mm) and 13 patients of stage IV OSMF (mouth opening less than 16 mm). The mean mouth opening of stage III group pre-operatively was 19.94 ± 2.19 mm which increased to a mean of 35.12 ± 5.69 mm (p < 0.0001). For patients with stage IV OSMF, the mouth opening increased from a pre-operative of 10.23 ± 4.07 mm to a post-operative of 31.46 ± 6.78 mm (p < 0.0001). No intra-operative complications were noted in any patient. Relapse was seen in 1 patient (5.8%) of stage III while 3 patients (23.07%) had relapse in stage IV group. Our results indicate that BFP is a good flap owing to its benefits which are easy to harvest and entails minimal morbidity for management of OSMF.

Buccal space tumours

OBJECTIVE

To review the available literature as it pertains to the buccal space with a specific focus on the pathologies encountered within this space. Clinical presentation, investigations, and surgical approaches to the region are also reviewed.

METHODS

A systematic review of the available literature was performed on buccal space tumours from 1980 to 2017. Data was extracted on clinical presentation, investigations and surgical approaches to the buccal space. The pathologies encountered in the buccal space were reviewed and presented.

RESULTS

Forty-nine unique articles were reviewed, with a total 217 patients. The age of the patients ranged from 0 to 83 with a mean age of 45.8. A total of 51 pathologies were reported. The majority of these were vascular and salivary gland pathologies. The majority of salivary gland neoplasms were malignant. However a wide variety of benign and malignant soft tissue tumours were also reported to occur in this region.

CONCLUSIONS

The buccal space is a small and complex region with a variety of pathologies occurring within it. This review clarifies the differential diagnosis of a mass which presents in this area and the pathologies which occur within it.

Buccal fat pad removal to improve facial aesthetics: an established technique?

Background

Buccal fat pad (BFP) is a singular structure between the facial muscles. Its removal may enhance the zygomatic prominences resulting in an inverted triangle of beauty. Objective: The aim of this study was to perform a systematic review of literature about BFP removal for facial aesthetic improvement. In order to answer the following research question: What are the indications, complication types and rates, surgical techniques and outcomes of the technique?

Material and Methods

The initial search in Pubmed, Scopus, and Cochrane databases recognized 220 articles. The final review included eight of them. None of the included studies were clinical trials.

Results

BPF removal was performed by intraoral incision or associated with the face lift procedure. In 71 patients submitted to the procedure and evaluated about complications, only 8.45% presented minor complications. Parotid duct and facial nerve injuries were not found. No study evaluated facial aging and long-term effects, therefore the harmless effect of the procedure to those features is not clear.

Conclusions

Although it is not a novel procedure, there is a lack of information about long-term outcomes. Thus, controlled clinical studies should be performed to achieve adequate clinical evidence of those aspects.

Key words:Buccal fat pad, facial sculpting, cheek surgery, buccal lipectomy.

Buccal Fat Pad: An Effective Option for Facial Reconstruction and Aesthetic Augmentation

INTRODUCTION

Autogenous grafting with lipoaspirate and dermo-fat grafting are popular techniques employed by plastic surgeons for correcting small volume facial defects and contour deformities. These techniques however present certain disadvantages. In this article, we present the use of the buccal fat pad graft as an alternative method of correcting such facial deformities.

PATIENTS AND METHODS

Free buccal fat pad grafting was carried out in 15 patients in our institution. All were harvested using an intraoral approach. The buccal fat pad graft was used to correct periorbital contour depressions, nasal tip deformities, as a camouflage graft over exposed silicon nasal implants and as a filler in the depression deformity after mass excision.

RESULTS

All 15 patients demonstrated good contour deformity correction without a significant graft resorption up to 3 years of follow-up. There were no donor site complications. The amount used ranged from 1 to 5 cc in volume as a spacer or barrier for the moderate-sized volume defect or depression, even though more than 5 cc of fat graft could be harvested if required.

CONCLUSION

In conclusion, the buccal fat pad graft represents an easy, expedient and exceptional tool for the correction of contour deformities, volume replacement or for aesthetic augmentation.

LEVEL OF EVIDENCE IV

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

A new space of the face: The bucco-mandibular space

Our previous studies based on intraoral dissection of fresh cadavers demonstrated the fissure and loose connective tissues behind the mucosa between the incisivus labii inferioris (ILI) and buccinator (BM) muscles. However, this raised new questions about the relationship among these muscles, the fissure and the buccal space. To our knowledge, no pathway to the oral cavity from the buccal space has been previously demonstrated, although such a pathway would better explain some routes of infection. Therefore, the aim of this study was to clarify the relationship among the mimetic muscles attached to the mandible, the fissure, and the buccal space. Twenty sides from 10 fresh frozen adult cadaveric Caucasian heads were used. The relationships among the ILI, BM, mandible, and buccal space were investigated with dissection and fluoroscopy. In all specimens, the fissure between the lateral border of the ILI and the anterior border of the BM formed the entrance of a space (here termed the bucco-mandibular space), which corresponded to the buccal mucosa in the premolar region. The superior border of this space was formed by the platysma and associated fascia, which was continuous with the masseteric fascia. This fascia clearly separated this space from the buccal space, which was located lateral to the BM and superior to this space. Clin. Anat. 30:958-962, 2017. © 2017 Wiley Periodicals, Inc.

The use of the buccal fat pad flap for oral reconstruction

Many congenital and acquired defects occur in the maxillofacial area. The buccal fat pad flap (BFP) is a simple and reliable flap for the treatment of many of these defects because of its rich blood supply and location, which is close to the location of various intraoral defects. In this article, we have reviewed BFP and the associated anatomical background, surgical techniques, and clinical applications. The surgical procedure is simple and has shown a high success rate in various clinical applications (approximately 90%), including the closure of oroantral fistula, correction of congenital defect, treatment of jaw bone necrosis, and reconstruction of tumor defects. The control of etiologic factors, size of defect, anatomical location of defect, and general condition of patient could influence the prognosis after grafting. In conclusion, BFP is a reliable flap that can be applied to various clinical situations.

Malar Augmentation with Pedicled Buccal Fat Pad in Orthognathic Surgery: Three-Dimensional Evaluation

BACKGROUND

Contemporary orthognathic surgery contemplates three-dimensional facial soft-tissue harmonization as one of the basic pillars in treatment planning. In particular, prominent malar regions are regarded as a sign of beauty and youth by Western societies. The aim of this article was to perform a subjective and objective three-dimensional evaluation of the pedicled buccal fat pad technique for malar augmentation in the context of orthognathic surgery.

METHODS

Six consecutive patients with underlying dentofacial anomalies and bilateral malar hypoplasia were managed with simultaneous orthognathic surgery and pedicled buccal fat pad malar augmentation. Patient morbidity and satisfaction with the procedure were evaluated with a visual analogue scale. Cone-beam computed tomographic data were used to perform a volumetric analysis at 1- and 12-month follow-up by means of image superimposition.

RESULTS

Subjective analysis revealed excellent patient satisfaction and minimal pain. Mean malar volume was 115,480.91 mm preoperatively, 124,586.32 mm 1 month after surgery, and 119,008.77 mm 12 months after surgery. Thus, the final mean increase 1 year after surgery was 3527.86 mm and the average amount of resorption was 5577.55 mm. The median variations in volume were 7.77 percent at 1-month follow-up and 3.52 percent at 12-month follow-up.

CONCLUSIONS

In conclusion, the pedicled buccal fat pad technique is a reasonable alternative for malar augmentation in the context of orthognathic surgery. The results of this preliminary report suggest that it provides satisfactory soft-tissue augmentation; avoids the use of foreign materials; and has minimal morbidity, high patient satisfaction, and adequate stability at 12-month follow-up.

CLINICAL QUESTION/LEVEL OF EVIDENCE

Therapeutic, IV.

Maxillary Segmental Micro Osteotomy: A Human Cadaver Study on the Efficacy of the Technique

PURPOSE

Ultrasonic bone cutting was recently introduced as a feasible alternative to the conventional tools of cranio-maxillofacial surgery because it offers improved precision and safety.This study examined the feasibility of minimally invasive orthodontic or preprosthetic surgery using a piezosurgery device for latero-posterior maxillary segmental osteotomy.

MATERIALS AND METHODS

Four fresh cadaveric heads were obtained for this study. Maxillary posterior osteotomy was performed using piezoelectric surgery. To preserve the vascular supply, only 1 vestibular incision was made during surgery. The Mectron Piezosurgery unit is a multipurpose device that uses micrometric ultrasonic piezoelectric vibrations with a variable frequency and cutting energy. The strategy for maxillary osteotomy included 1 horizontal osteotomy, 2 vertical osteotomies, and 1 palatal osteotomy performed transantrally without incision of the mucoperiosteum. The osteotomies were performed using a piezodevice (OT7-type inserts: 0.55 and 0.35 mm). In total, 1 horizontal cut (3 mm above the roots of the teeth), 2 vertical bone cuts, and 1 palatal osteotomy were made without incision of the palatal mucoperiosteum.Gentle dissection of the buccal fat pad was used to promote the healing of hard and soft tissues in the osteotomized zone.

RESULTS

No damage to soft tissues, including the palatal mucosa, occurred. The buccal fat pad was mobilized easily without requiring an additional incision. The osteotomic sites were linear and clean in the palatal aspect. The integrity of the vascular network was maintained because of the lack of damage to the palatal mucosa. No chisels were used during the osteotomies.

DISCUSSION

This cadaveric study shows the feasibility of using piezosurgery for segmental maxillary osteotomy. This report outlines a new and simple application of segmental maxillary micro-osteotomy.

Deep fat of the face revisited

The midfacial deep fatty tissue has been divided into the buccal and parapharyngeal fat pads although the former carries several extensions in adults. Using histological sections of 15 large human fetuses, we demonstrated that the parapharyngeal fat pad corresponds to the major content of the prestyloid compartment of the parapharyngeal space or, simply, the prestyloid fat. The buccal and prestyloid fatty tissues were separated by the medial and lateral pterygoid muscles. In these tissues, superficial parts, corresponding to the lower body and the masseteric extension of the adult buccal fat pad, were well encapsulated and showed the most advanced stage of histogenesis. As the sphenoid bone was not fully developed even in the largest specimens, the temporal, infratemporal, and pterygopalatine fossae joined to provide a large space for a single, large upper extension of the buccal fat pad. In the intermediate part of the extension course, the larger specimens carried a narrower part between the maxilla and the temporalis muscle. The single, upper extension appeared to divide into several extensions, as seen in adults. The periocular fat was clearly separated from the upper extension of the buccal fat pad by the sheet-like orbitalis muscle. A communication between the prestyloid fat and the buccal fat pad likely occurred through a potential space along the lingual nerve immediately superior to the deep part of the submandibular gland. At this site, therefore, the prestyloid fat may be injured or infected when the buccal fat pad is treated surgically.

Effectiveness of buccal fat in closing residual midpalatal and posterior palatal fistulas in patients previously treated for clefts

PURPOSE

The present retrospective study assessed the outcome and effectiveness of the buccal fat pad flap for closure of postoperative midpalatal fistulas and fistulas of the posterior palate in patients previously treated for cleft palate.

PATIENTS AND METHODS

The charts of 29 patients with residual midpalatal and posterior palatal fistulas treated using buccal fat pad flaps were assessed. Of the 29 patients, 18 were males and 11 were females, aged 2.5 to 19 years. The fistula size was 10 to 20 mm.

RESULTS

Full epithelialization of the flap had occurred within 4 weeks in all 29 patients. The fistulas had completely closed in 28 patients. In 1 patient, a 2-mm defect was noted in the anterior part of the fistula repair that had healed after 2 months without intervention.

CONCLUSION

The buccal fat pad flap can be used to repair any remaining postoperative palatal fistulas that are 10 to 20 mm in size.