Pedicled buccal fat pad for the augmentation of facial depression deformity: A case report

Study on the Application of Concentrated Growth Factor Combined With Adipose Transplantation in Repairing Depressed Deformities of Soft Tissue in the Face

BACKGROUND

Autologous fat is a rich source of adipose tissue that is safe for transplantation. Decreasing the long-term absorption rate is key to improve the survival of transplanted adipose tissue. The aim of this study was to assess the effect of concentrated growth factor (CGF) on the survival of transplanted adipose tissue for repair of facial depression malformations.

METHODS

Coleman adipose granules (CAGs) were prepared from venous blood. In the animal experiment, the ears of 30 healthy male New Zealand white rabbits were randomly allocated to 1 of 4 groups: CGF + CAG (CGF group), platelet-rich fibrin (PRF) + CAG (PRF group), CAG alone (CAG group), and adipose granule transplantation group (control group). Postoperative survival of the transplanted adipose tissue was assessed, the survival and absorption rates of adipose were calculated, and immunohistochemical analysis of specimens was conducted by staining with hematoxylin and eosin and Oil Red O. Of 43 outpatients, 22 received simple adipose transplantation and 21 received autologous CGF combined with adipose transplantation. The adipose absorption rate, complication rate, and cosmetic improvement of the 2 groups were compared.

RESULTS

More adipocytes that are normal were observed in the CGF group, with fewer vacuoles and more uniform distribution of adipose tissue. Survival of the adipose tissue was superior in the CGF and PRF groups. Meanwhile, vascular density and long-term stability were better in the CGF group than the PRF group. In terms of clinical efficacy, the uniformity and survival rate of the adipose tissue were relatively improved in the CGF group compared with the simple adipose particle transplantation group, with less early liquefaction.

CONCLUSION

Concentrated growth factor stabilized and improved the survival of transplanted adipose tissue for filling of facial depression malformations.

Buccal Fat Pad for Interpositional Arthroplasty in Temporomandibular Joint Ankylosis

Aim

The buccal fat pad (BPF) is a readily accessible mass of adipose tissue in the oro-maxillofacial region. It is a specialized type of fat tissue that enhances intermuscular motion. It has been used extensively for reconstruction of oral cavity defects with satisfactory outcomes. However, its use as an interpositional material in the management of temporomandibular joint ankylosis is not widespread. This report aims to present our experience with its use as an interpositional tissue in the management of temporomandibular joint ankylosis.

Materials and Methods

A total of four patients who presented with either unilateral or bilateral temporomandibular joint ankylosis were included in this study. Three patients presented with bilateral temporomandibular joint ankylosis while one patient had right unilateral bony ankylosis of the temporomandibular joint. All the patients were treated under general anaesthesia during which airway was maintained intraoperatively using tracheostomy tubes. In all cases, interpositional arthroplasty using BPF as the interpositional material was done.

Results

There were two males and two females with age range between 4 and 24 years and a median age of 12.5 years. Trauma was the aetiological factor in all cases. There were a total of seven ankylosed joints. Autogenous pedicled BPF was used in five joints, while BPF graft was utilized in two joints. Maximal interincisal opening of 35 mm or more was achieved intraoperatively before placement of the BPF in all cases. Immediate postoperative jaw exercise was commenced. Mouth opening remained satisfactory at all postoperative reviews.

Conclusion

Buccal fat pad is a reliable option for interpositional arthroplasty in the management of TMJ ankylosis, and it can be used either as a free graft or as a pedicled flap.