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Adekunle AA, James O, Olanbiwonnu AO, Adeyemo WL. A Review of the Use of Buccal Fat Pad in Cleft Palate Repair. Cleft Palate Craniofac J 2024; 61:1116-1124. [PMID: 36760091 DOI: 10.1177/10556656231155768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/11/2023] Open
Abstract
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.
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Affiliation(s)
- Adegbayi Adeola Adekunle
- Department of Oral and Maxillofacial Surgery, Lagos University Teaching Hospital, Lagos, Nigeria
| | - Olutayo James
- Department of Oral and Maxillofacial Surgery, College of Medicine, University of Lagos/Lagos University Teaching Hospital, Lagos, Nigeria
| | | | - Wasiu Lanre Adeyemo
- Department of Oral and Maxillofacial Surgery, College of Medicine, University of Lagos/Lagos University Teaching Hospital, Lagos, Nigeria
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Romero-Narvaez C, Lin LO, Kirschner RE. Buccal Fat Pad in Primary and Secondary Cleft Palate Repair: A Systematic Review of the Literature. Cleft Palate Craniofac J 2023:10556656231206238. [PMID: 37853550 DOI: 10.1177/10556656231206238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2023] Open
Abstract
OBJECTIVE To review the evidence supporting the use of buccal fat pad (BFP) in primary and secondary cleft palate repair and its short- and long- term clinical outcomes. DESIGN Systematic review conducted by 2 independent reviewers following PRISMA guidelines. SETTING: NONE PARTICIPANTS Articles were identified from three databases (Pubmed/Medline, Embase and Web of Science). Search terms included "cleft palate", "palatoplasty", "palate repair", "buccal fat pad". INTERVENTIONS Use of BFP in primary and secondary cleft palatoplasty. MAIN OUTCOME MEASURES Primary outcomes were immediate postoperative complications, postoperative fistula, and maxillary growth. Secondary outcomes were palatal length, speech, and donor site morbidity. RESULTS Ninety-one reports were retrieved after excluding duplicates. Twenty-three studies were included (13 case series and 10 comparative studies). Overall level of evidence was low. Randomized and non-randomized studies had a high risk of bias. In primary palatoplasty, BFP was more frequently used filling lateral relaxing incisions(57.4%), or in the hard-soft palate junction and covering mucosal defects(30.1%). In these patients, post operative fistula incidence was 2.8%. Two studies found wider transverse maxillary dimensions after BFP use. No higher incidence of bleeding, infection, dehiscence, or flap necrosis was reported. In secondary palatoplasty, no recurrent fistulas were reported for patients undergoing BFP for fistula repair. CONCLUSIONS BFP appears to be associated with a favorable impact in fistula prevention and management, as well as in transverse maxillary growth. However, there is a high heterogeneity among studies, high risk of bias and overall low quality of evidence. More high-quality research with long-term follow-up is warranted.
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Affiliation(s)
- Carolina Romero-Narvaez
- Plastic and Reconstructive Surgery Service, Hospital Nacional Edgardo Rebagliati Martins, Lima, Peru
| | - Lawrence O Lin
- Department of Plastic and Reconstructive Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Richard E Kirschner
- Plastic and Reconstructive Surgery Service, Hospital Nacional Edgardo Rebagliati Martins, Lima, Peru
- Plastic Surgery, The Ohio State University College of Medicine, Columbus, OH, USA
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Park H, Choi JM, Oh TS. Double-opposing Z-Plasty Extended with a Pedicled Buccal Fat Pad Flap for Correcting Velopharyngeal Insufficiency after Primary Palatoplasty. Cleft Palate Craniofac J 2021; 59:1445-1451. [PMID: 34636625 DOI: 10.1177/10556656211047139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
INTRODUCTION Furlow double-opposing Z-plasty (DOZ) lengthens the soft palate; however, this lengthening is achieved at the expense of increased mucosal flap tension. Thus, its use is limited in patients with severe tension applied on mucosal flap after DOZ. In this study, DOZ was combined with a buccal fat pad (BFP) flap to maximize palatal lengthening and muscle repositioning. METHODS This study included patients who underwent surgical correction for velopharyngeal insufficiency between December 2016 and February 2019. Patients with more than moderate degree hypernasality following primary palatoplasty were included in the study. Patients younger than 4 years of age, those with a submucous cleft palate, or syndromic patients were excluded. Speech outcomes were investigated for those who underwent DOZ only (DOZ group, n = 17) and those in whom a BFP was used (BFP group, n = 15) pre- and postoperatively. The velopharyngeal gaps between the uvula and pharyngeal wall were measured before and immediately after surgery to estimate the palatal length. RESULTS Most patients who received a BFP showed improvement in hypernasality. However, the hypernasality of the DOZ group was more severe than that of the BFP group (p = 0.023). The extent of palatal lengthening was 4.4 ± 1.7 mm and 7.5 ± 2.1 mm in the DOZ and BFP groups, respectively (p = 0.001). CONCLUSIONS BFPs reduced the tension of the DOZ mucosal flap and maximized palatal lengthening and muscle repositioning. They promoted velopharyngeal closure in patients with moderate and moderate-to-severe velopharyngeal insufficiency. Hence, our method improves the surgical outcomes of patients with velopharyngeal insufficiency after primary palatoplasty.
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Affiliation(s)
- Hojin Park
- Asan Medical Center, 65526University of Ulsan College of Medicine, Seoul, Korea
| | - Jin Mi Choi
- Asan Medical Center, 65526University of Ulsan College of Medicine, Seoul, Korea
| | - Tae Suk Oh
- Asan Medical Center, 65526University of Ulsan College of Medicine, Seoul, Korea
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Echlin K, Whitehouse H, Schwaiger M, Nicholas R, Fallico N, Atherton DD. A Cadaveric Study of the Buccal Fat Pad: Implications for Closure of Palatal Fistulae and Donor-Site Morbidity. Plast Reconstr Surg 2020; 146:1331-1339. [PMID: 33234964 DOI: 10.1097/prs.0000000000007351] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
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.
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Affiliation(s)
- Kezia Echlin
- From Birmingham Children's Hospital; and South Thames Cleft Service, Guy's and St Thomas' Hospital
| | - Harry Whitehouse
- From Birmingham Children's Hospital; and South Thames Cleft Service, Guy's and St Thomas' Hospital
| | - Michael Schwaiger
- From Birmingham Children's Hospital; and South Thames Cleft Service, Guy's and St Thomas' Hospital
| | - Rebecca Nicholas
- From Birmingham Children's Hospital; and South Thames Cleft Service, Guy's and St Thomas' Hospital
| | - Nefer Fallico
- From Birmingham Children's Hospital; and South Thames Cleft Service, Guy's and St Thomas' Hospital
| | - Duncan D Atherton
- From Birmingham Children's Hospital; and South Thames Cleft Service, Guy's and St Thomas' Hospital
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The Effect of Buccal Fat Pad Graft in the Palatoplasty and the Risk Factor of Postoperative Palatal Fistula. J Craniofac Surg 2020; 31:658-661. [PMID: 31985598 DOI: 10.1097/scs.0000000000006151] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Abstract
BACKGROUND Regardless of the technique chosen to treat the aging midface, the isolated lateral approach facelift has a limited impact on the midface volume deficit. In an effort to overcome this limitation, modern facial rejuvenation procedures incorporate an additional modality for replenishing the midface volume. Some of the author's facelift patients present with bulging buccal fat pads despite volume deficiency in the inframalar region. The author's technique is designed to utilize the buccal fat pad to replenish the inframalar volume deficit. OBJECTIVES The author sought to present the fat pad transposition surgical technique along with objective outcome data. METHODS This study was a retrospective review of nonconsecutive cases where the sub-superficial-musculo-aponeurotic-system transposition of the buccal fat pad was performed. A total of 22 patients underwent the fat pad transposition technique by the author (O.B.) between July 2013 and December 2017. Patient data were obtained from patient records, 3-dimensional models, magnetic resonance images, and standardized photography. Preoperative differences in midface volume were assessed utilizing curvilinear surface measurements on 3-dimensional models and the Allergan midface volume deficit scale on standardized photography. RESULTS The average midface volume deficit score significantly improved, and the average midfacial curvilinear surface measurement significantly increased after surgery. Magnetic resonance imaging confirmed a stable position of the buccal fat pad after surgery. CONCLUSIONS The sub-superficial-musculo-aponeurotic-system transposition of the buccal fat pad is an effective technique that can be safely employed for autologous inframalar augmentation in patients with a favorable facial morphology. LEVEL OF EVIDENCE: 4
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Ayyash AM, Anstadt EE, Dvoracek LA, Marji FP, Lee JY, Losee JE, Goldstein JA. An Intraoperative Salvage After Transection of the Greater Palatine Artery During Cleft Palate Repair: A Case for Buccal Fat and Buccal Myomucosal Flaps. J Craniofac Surg 2020; 31:e133-e135. [PMID: 31934976 DOI: 10.1097/scs.0000000000006037] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Recently, several adjunctive procedures have gained traction to aid cleft surgeons in repairing especially challenging palatal clefts. Buccal fat flaps and buccal myomucosal flaps have demonstrated particular utility in reinforcing thin palatal flaps or tissue deficits. Although their use has not been widely accepted, they may be particularly helpful in the setting of significant scarring or vascular compromise. Here the authors describe the case of an intraoperative salvage using bilateral buccal fat flaps and a right buccal myomucosal flap after transection of the right Greater Palatine artery (GPA) during palatoplasty on a 14-month old female with Pierre Robin Sequence and a wide Veau II cleft palate. For this operative salvage, bilateral buccal fat flaps were used to reinforce the hard-soft palate junction and a 4 cm × 2 cm flap of the right-sided buccal mucosa and buccinator muscle was inset along the majority of the right-sided soft and posterior hard palate. At 2 years follow-up, the patient had no significant complications and was doing well with healthy-appearing palatal tissue and age-appropriate speech.
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Affiliation(s)
| | - Erin E Anstadt
- Department of Plastic Surgery, University of Pittsburgh Medical Center, PA
| | - Lucas A Dvoracek
- Department of Plastic Surgery, University of Pittsburgh Medical Center, PA
| | - Fady P Marji
- Department of Plastic Surgery, University of Pittsburgh Medical Center, PA
| | | | - Joseph E Losee
- Department of Plastic Surgery, University of Pittsburgh Medical Center, PA
| | - Jesse A Goldstein
- Department of Plastic Surgery, University of Pittsburgh Medical Center, PA
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Large Anterior Oronasal Fistula Repair Using Pedicled Buccal Fat Pad and Fibroepithelial Tissue. J Craniofac Surg 2020; 30:2618-2620. [PMID: 31567770 DOI: 10.1097/scs.0000000000005971] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Oronasal fistula (ONF) is the most common complication after palatoplasty in patients with cleft lip and palate (CLP). When left untreated, it may negatively affect the quality of life, leading to development of other comorbidities. This study reports for the first time, the use of a portion of a hyperplasic tissue associated with pedicled buccal fat pad flap to repair a large anterior ONF in a 60-year-old man. The hyperplasic tissue may have developed due to the combination of a loose fitting upper denture and long-term use of dihydropyridine calcium channel blocker (amlodipine besylate). There is controversy in the literature about use of pedicled buccal fat pad flap in the anterior region. However, in this study, we report successful repair of a large anterior ONF using a portion of a fibroepithelial hyperplasic tissue associated with pedicled buccal fat pad flap.
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Mannelli G, Arcuri F, Comini L, Valente D, Spinelli G. Buccal Fat Pad: Report of 24 Cases and Literature Review of 1,635 Cases of Oral Defect Reconstruction. ORL J Otorhinolaryngol Relat Spec 2018; 81:24-35. [DOI: 10.1159/000494027] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Accepted: 09/25/2018] [Indexed: 11/19/2022]
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10
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Comini LV, Spinelli G, Mannelli G. Algorithm for the treatment of oral and peri-oral defects through local flaps. J Craniomaxillofac Surg 2018; 46:2127-2137. [DOI: 10.1016/j.jcms.2018.09.023] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Revised: 07/23/2018] [Accepted: 09/19/2018] [Indexed: 02/07/2023] Open
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An Update on Osteomyelitis Treatment in a Pycnodysostosis Patient. J Oral Maxillofac Surg 2018; 76:2136.e1-2136.e10. [DOI: 10.1016/j.joms.2018.06.026] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Revised: 06/07/2018] [Accepted: 06/08/2018] [Indexed: 01/01/2023]
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12
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Harvesting the Buccal Fat Pad Does Not Result in Aesthetic Deformity in Cleft Patients. Plast Reconstr Surg 2017; 140:362-368. [DOI: 10.1097/prs.0000000000003521] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Abstract
The buccal fat pad (BFP) is a well-established tool in oral and maxillofacial surgery and its use has proved of value for the closure of oroantral communications. Oroantral communication may be a common complication after sequestrectomy in "bisphosphonate-related osteonecrosis of the jaws."The authors report a clinical case of a 70-year-old female patient in bisphosphonate therapy presented with right maxillary sinusitis and oroantral communication after implants insertion.The BFP was used to close the defect. The patient had an uneventful postoperative healing without dehiscence, infection, and necrosis.The authors postulate that the primary closure of the site with BFP may ensure a sufficient blood supply and adequate protection for an effective bone-healing response to occur.
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Kim MK, Han W, Kim SG. The use of the buccal fat pad flap for oral reconstruction. Maxillofac Plast Reconstr Surg 2017; 39:5. [PMID: 28286743 PMCID: PMC5325802 DOI: 10.1186/s40902-017-0105-5] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2016] [Accepted: 02/01/2017] [Indexed: 11/10/2022] Open
Abstract
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.
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Affiliation(s)
- Min-Keun Kim
- Department of Oral and Maxillofacial Surgery, College of Dentistry, Gangneung-Wonju National University, 7 Jukhyun-gil, Gangneung, 25457 Republic of Korea
| | - Wonil Han
- Han Dental Clinic, Guri, Republic of Korea
| | - Seong-Gon Kim
- Department of Oral and Maxillofacial Surgery, College of Dentistry, Gangneung-Wonju National University, 7 Jukhyun-gil, Gangneung, 25457 Republic of Korea
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Erdenetsogt J, Ayanga GN, Tserendulam D, Bayasgalan R. The closure of postpalatoplasty fistula with local turn-down flap. Ann Maxillofac Surg 2016; 5:271-3. [PMID: 26981487 PMCID: PMC4772577 DOI: 10.4103/2231-0746.175776] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Introduction: The three common complications after cleft palate repair are velopharyngeal incompetence, delayed maxillary growth, and fistula formation. Fistula formation rates are reported 0–76% in the literature. Wider palatal defects are more challenging to avoid excess tension, and recent reports suggest defects >15 mm have a significantly higher risk of fistula formation. By localization, the fistulas are divided into seven groups with Pittsburgh fistula classification system (PFCS). The timing of treatment of fistula can vary considerably, and a recurrence rate after surgical correction ranges 10–37%. Materials and Methods: Three patients with fistula in the hard palate (PFCS-4) in size 7–12 mm, between 2010 and 2012, who underwent fistula repair with local turn-down flap. In two cases, surgery was the first fistula repair and was the second repair in one case. The incisions in the frontal and bilateral edges were made around the fistula, in the distal side of fistula incision was made 3–5 mm longer than fistula size in the oral mucosa, and separate oral and nasal mucosa was rendered by organizing flap. This flap was turn-down and closed nasal side of fistula. The oral side of fistula was closed with the two-flap procedure by Bardach technique. Results: The postoperative wound was covered initially in all cases. Conclusion: We believe this two layer method for correction big palatal fistula is simpler than tongue, and buccal flap and patients need only intervention in this case. In addition, this method involves more effective usage of mucosal tissues bilaterally for closure on the oral side of the defect.
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Affiliation(s)
- J Erdenetsogt
- Department of Maxillofacial Surgery, National Center for Maternal and Child Health of Mongolia, Huvisgalchdiin, Bayangol, Ulaanbaatar, Mongolia
| | - G N Ayanga
- Department of Maxillofacial Surgery, National Center for Maternal and Child Health of Mongolia, Huvisgalchdiin, Bayangol, Ulaanbaatar, Mongolia
| | - D Tserendulam
- Department of Maxillofacial Surgery, National Center for Maternal and Child Health of Mongolia, Huvisgalchdiin, Bayangol, Ulaanbaatar, Mongolia
| | - R Bayasgalan
- Department of Maxillofacial Surgery, National Center for Maternal and Child Health of Mongolia, Huvisgalchdiin, Bayangol, Ulaanbaatar, Mongolia
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Use of the buccal fat pad as free graft for closure of oronasal fistula in a cleft palate patient. J Craniofac Surg 2015; 26:e14-6. [PMID: 25565230 DOI: 10.1097/scs.0000000000001225] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Oronasal fistulas are frequent complications after cleft lip and palate surgery, with difficult treatment because of the presence of fibrotic and scarred tissue as well as the absence of local virgin tissue, representing a challenge in oral and maxillofacial surgery. The size of the fistula, its location, and the cause of the defect are important factors to determine the type of treatment and surgical technique. The use of pedicled buccal fat pad (BFP) for the repair of cleft palate has shown promising results, becoming a safe and effective method. On the other hand, the use of BFP as a free graft for oral defects has been rarely described in the literature. The current study is the first case report that shows the use of free graft of BFP in oronasal fistula after cleft lip and palate surgery and aimed to discuss the promising results of this surgical technique, suggesting it as a treatment option for anterior maxillary defects, when properly indicated.
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Duarte LFM, Alonso K, Basso EC, Dib LL. Surgical Treatment of Bisphosphonate-Related Osteonecrosis of the Jaws with the Use of Buccal Fat Pad: Case Report. Braz Dent J 2015. [DOI: 10.1590/0103-6440201301918] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Bisphosphonate-related osteonecrosis of the jaws (BROJ) has been described since 2003 as an adverse effect of bisphosphonate medications. These drugs act on the vasculature and bone remodeling, mainly on osteoclastic activity and can cause areas of necrotic bone exposure. Treatment for the BROJ is not yet defined, but surgical treatment is one of the forms proposed, which may cause oral deformities like sinus communication in some cases. In situations like this the buccal fat pad is an important alternative for coating nasal-oral communications, due its large blood supply, elasticity, absence of restriction by age and safety. This paper presents the case of a 58-year-old woman with BROJ in the left maxilla caused by the use of zoledronic acid for metastatic breast cancer. The extensive necrotic bone area was surgically removed resulting in oral sinus communication. A buccal fat pad was used to cover the defect. More studies should be performed regarding the treatment of BROJ but, if necessary, a buccal fat pad flap could be an alternative to solve nasal-oral communications related to BROJ.
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Conservative management of medication-related osteonecrosis of the maxilla with an obturator prosthesis. J Prosthet Dent 2015; 113:236-41. [DOI: 10.1016/j.prosdent.2014.08.010] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2014] [Revised: 08/19/2014] [Accepted: 08/19/2014] [Indexed: 11/18/2022]
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Tavakolinejad S, Ebrahimzadeh Bidskan A, Ashraf H, Hamidi Alamdari D. A glance at methods for cleft palate repair. IRANIAN RED CRESCENT MEDICAL JOURNAL 2014; 16:e15393. [PMID: 25593724 PMCID: PMC4270645 DOI: 10.5812/ircmj.15393] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/20/2013] [Revised: 01/13/2014] [Accepted: 01/21/2014] [Indexed: 01/17/2023]
Abstract
Context: Cleft palate is the second most common birth defect and is considered as a challenge for pediatric plastic surgeons. There is still a general lack of a standard protocol and patients often require multiple surgical interventions during their lifetime along with disappointing results. Evidence Acquisition: PubMed search was undertaken using search terms including 'cleft palate repair', 'palatal cleft closure', 'cleft palate + stem cells', 'cleft palate + plasma rich platelet', 'cleft palate + scaffold', 'palatal tissue engineering', and 'bone tissue engineering'. The found articles were included if they defined a therapeutic strategy and/or assessed a new technique. Results: We reported a summary of the key-points concerning cleft palate development, the genes involving this defect, current therapeutic strategies, recently novel aspects, and future advances in treatments for easy and fast understanding of the concepts, rather than a systematic review. In addition, the results were integrated with our recent experience. Conclusions: Tissue engineering may open a new window in cleft palate reconstruction. Stem cells and growth factors play key roles in this field.
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Affiliation(s)
- Sima Tavakolinejad
- Department of Anatomy and Cell Biology, School of Medicine, Mashhad University of Medical Sciences, Mashhad, IR Iran
| | - Alireza Ebrahimzadeh Bidskan
- Department of Anatomy and Cell Biology, School of Medicine, Mashhad University of Medical Sciences, Mashhad, IR Iran
| | - Hami Ashraf
- Student Research Committee, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, IR Iran
| | - Daryoush Hamidi Alamdari
- Biochemistry and Nutrition Research Center, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, IR Iran
- Corresponding Author: Daryoush Hamidi Alamdari, Biochemistry and Nutrition Research Center, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, IR Iran. Tel: +98-9151017650, E-mail:
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A Clinical Study of Various Buccinator Musculomucosal Flaps for Palatal Fistulae Closure After Cleft Palate Surgery. J Craniofac Surg 2014; 25:e197-202. [DOI: 10.1097/scs.0000000000000411] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Khiabani K, Keyhan SO, Varedi P, Hemmat S, Razmdideh R, Hoseini E. Buccal fat pad lifting: an alternative open technique for malar augmentation. J Oral Maxillofac Surg 2013; 72:403.e1-15. [PMID: 24438602 DOI: 10.1016/j.joms.2013.10.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2013] [Revised: 10/01/2013] [Accepted: 10/01/2013] [Indexed: 11/26/2022]
Abstract
PURPOSE The purpose of the study was to introduce a novel technique for malar augmentation using buccal fat pad pedicle flaps and to evaluate the long-term results and complications of the technique. MATERIALS AND METHODS The investigators designed and conducted a prospective clinical trial. Patients underwent unilateral malar augmentation surgery using buccal fat pad pedicle flaps from June 2011 through June 2012. Patients underwent surgery for esthetic reasons or for trauma with severely comminuted or old zygomaticomaxillary complex fractures that could not be reduced precisely. The primary predictor variable was the buccal fat pad pedicle flap technique. The primary outcome variables included the amount of augmentation and resorption (which was estimated by comparing pre- with postsurgical photographic views), pain, edema, bruising, and nerve and parotid duct injuries. RESULTS Thirteen patients (8 men and 5 women) underwent malar augmentation in the cheekbone area using the buccal fat pad pedicle flap technique. One year after surgery, the average amount of resorption was 0.376 mm. Other major complications, such as prolonged bruising, massive hematoma, intense pain, asymmetry, and parotid duct injury, were not observed. CONCLUSION These results indicate that this new open-access technique should be considered an alternative method for the management of mild to moderate malar depression in patients undergoing esthetic and post-trauma surgery.
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Affiliation(s)
- Kazem Khiabani
- Assistant Professor, Department of Oral and Maxillofacial Surgery, Jundishapour University of Medical Science, Ahvaz, Iran.
| | - Seied Omid Keyhan
- Assistant Professor, Department of Oral and Maxillofacial Surgery, Craniomaxillofacial Research Center, Shahid Rahnemoon Hospital, Yazd, Iran
| | - Payam Varedi
- Chief Resident, Department of Oral and Maxillofacial Surgery, Craniomaxillofacial Research Center, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Seifollah Hemmat
- Assistant Professor, Department of Oral and Maxillofacial Surgery, Bandar Abbas University of Medical Science, Bandar Abbas, Iran
| | - Roohollah Razmdideh
- Resident, Department of Oral and Maxillofacial Surgery, Jundishapour University of Medical Science, Ahvaz, Iran
| | - Elham Hoseini
- Resident, Department of Oral and Maxillofacial Surgery, Jundishapour University of Medical Science, Ahvaz, Iran
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