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Huang H, Qiao Q, Zhao N, Zhou Y, Zou Y, Li Q, Li S, Zhou B, Zhang Y, Guo C, Guo Y. Efficacy of submental island flap closing advanced mandibular MRONJ lesion in malignancy patients. Head Neck 2024; 46:2315-2326. [PMID: 38850095 DOI: 10.1002/hed.27837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2024] [Revised: 04/18/2024] [Accepted: 05/27/2024] [Indexed: 06/09/2024] Open
Abstract
OBJECTIVE This study evaluated the effectiveness of a submental island flap in closing advanced mandibular medication-related osteonecrosis of the jaw (MRONJ) wounds in patients with malignant tumors. SUBJECTS AND METHODS A total of 85 patients with stage II and III MRONJ of mandible with malignant tumor as their primary disease were retrospectively analyzed. All patients underwent surgical treatment, and the soft tissue wound closure was performed either with a submental island flap (SIF) or mucoperiosteal flap (MF). Univariate and multifactorial models were applied to analyze the factors influencing patients' prognosis. RESULTS Univariate analysis (p = 0.004, OR 0.075-0.575, 95% CI) and binary logistic regression (p = 0.017, OR 0.032-0.713, 95% CI) suggested that the surgical prognosis of SIF wound closure was significantly better than that of MF. CONCLUSION Closure of wound after resection of mandibular MRONJ lesions in patients with malignant tumors using SIF had a better clinical prognosis compared with MF.
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Affiliation(s)
- Hongyuan Huang
- Department of Oral and Maxillofacial Surgery, Peking University Stomatological Hospital, Beijing, China
- National Clinical Research Center for Oral Diseases, Beijing, China
- National Engineering Research Center of Oral Biomaterials and Digital Medical Devices, Beijing, China
- Beijing Key Laboratory of Digital Stomatology, Peking University School and Hospital of Stomatology, Beijing, China
| | - Qiao Qiao
- Department of Oral and Maxillofacial Surgery, Peking University Stomatological Hospital, Beijing, China
- National Clinical Research Center for Oral Diseases, Beijing, China
- National Engineering Research Center of Oral Biomaterials and Digital Medical Devices, Beijing, China
- Beijing Key Laboratory of Digital Stomatology, Peking University School and Hospital of Stomatology, Beijing, China
| | - Ning Zhao
- Department of Oral and Maxillofacial Surgery, Peking University Stomatological Hospital, Beijing, China
- National Clinical Research Center for Oral Diseases, Beijing, China
- National Engineering Research Center of Oral Biomaterials and Digital Medical Devices, Beijing, China
- Beijing Key Laboratory of Digital Stomatology, Peking University School and Hospital of Stomatology, Beijing, China
| | - Ying Zhou
- Department of Oral and Maxillofacial Surgery, Peking University Stomatological Hospital, Beijing, China
- National Clinical Research Center for Oral Diseases, Beijing, China
- National Engineering Research Center of Oral Biomaterials and Digital Medical Devices, Beijing, China
- Beijing Key Laboratory of Digital Stomatology, Peking University School and Hospital of Stomatology, Beijing, China
| | - Yiwen Zou
- Department of Oral and Maxillofacial Surgery, Peking University Stomatological Hospital, Beijing, China
- National Clinical Research Center for Oral Diseases, Beijing, China
- National Engineering Research Center of Oral Biomaterials and Digital Medical Devices, Beijing, China
- Beijing Key Laboratory of Digital Stomatology, Peking University School and Hospital of Stomatology, Beijing, China
| | - Qingxiang Li
- Department of Oral and Maxillofacial Surgery, Peking University Stomatological Hospital, Beijing, China
- National Clinical Research Center for Oral Diseases, Beijing, China
- National Engineering Research Center of Oral Biomaterials and Digital Medical Devices, Beijing, China
- Beijing Key Laboratory of Digital Stomatology, Peking University School and Hospital of Stomatology, Beijing, China
| | - Siyuan Li
- Department of Oral and Maxillofacial Surgery, Peking University International Hospital, Beijing, China
| | - Biao Zhou
- Department of Stomatology, Baoding Second Hospital, Baoding, China
| | - Yi Zhang
- Department of Oral and Maxillofacial Surgery, Peking University Stomatological Hospital, Beijing, China
- National Clinical Research Center for Oral Diseases, Beijing, China
- National Engineering Research Center of Oral Biomaterials and Digital Medical Devices, Beijing, China
- Beijing Key Laboratory of Digital Stomatology, Peking University School and Hospital of Stomatology, Beijing, China
- Department of Oral and Maxillofacial Surgery, Peking University International Hospital, Beijing, China
| | - Chuanbin Guo
- Department of Oral and Maxillofacial Surgery, Peking University Stomatological Hospital, Beijing, China
- National Clinical Research Center for Oral Diseases, Beijing, China
- National Engineering Research Center of Oral Biomaterials and Digital Medical Devices, Beijing, China
- Beijing Key Laboratory of Digital Stomatology, Peking University School and Hospital of Stomatology, Beijing, China
| | - Yuxing Guo
- Department of Oral and Maxillofacial Surgery, Peking University Stomatological Hospital, Beijing, China
- National Clinical Research Center for Oral Diseases, Beijing, China
- National Engineering Research Center of Oral Biomaterials and Digital Medical Devices, Beijing, China
- Beijing Key Laboratory of Digital Stomatology, Peking University School and Hospital of Stomatology, Beijing, China
- Department of Oral and Maxillofacial Surgery, Peking University International Hospital, Beijing, China
- Department of Stomatology, Baoding Second Hospital, Baoding, China
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Davis SJ, Park C, Shipchandler IT, Abdulhak A, Vernon D, Lee HB, Mantravadi AV, Ting J, Shipchandler TZ. Buccal Fat Advancement-Transposition Flap for Reconstruction of Midface Volume Defects. Facial Plast Surg Aesthet Med 2024; 26:497-502. [PMID: 38597716 DOI: 10.1089/fpsam.2023.0303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/11/2024] Open
Abstract
Background: The buccal fat pad (BFP) has previously been utilized for repair of various defects of the head and neck. Objectives: We explore the utility of a pedicled buccal fat advancement-transposition (BFAT) flap in various forms of midface reconstruction through a variety of surgical approaches and characterize its volume and axial reach in human anatomic specimens. Methods: Ten adult full-head human anatomic specimens were dissected, and a single surgical case demonstrating the use of a BFAT flap is described. Results: Nasolabial, subciliary, and deep plane facelift incisions all provided access to the BFP for use as a BFAT flap. The mean volume of mobilizable fat contained within a BFAT flap accessible through external incision was 7.1 cm3. Once fully mobilized, the externalized BFAT flap had a mean axial reach of 6.9 cm without tension. We also present a case illustrating the successful use of a BFAT flap for volumization of a large midface defect secondary to Mohs micrographic surgical resection of a cutaneous malignancy. Discussion: The BFAT flap, which exhibited substantial volume and reach in this study, can be harvested through multiple dissection windows or pre-existing defects and be used to reconstruct a variety of midface defects.
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Affiliation(s)
- Seth J Davis
- Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Palo Alto, CA, 94301
| | - Christopher Park
- Department of Otolaryngology-Head and Neck Surgery, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Isaac T Shipchandler
- Department of Otolaryngology-Head and Neck Surgery, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Abraham Abdulhak
- Department of Dermatology, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Dominic Vernon
- Department of Otolaryngology-Head and Neck Surgery, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Hui Bae Lee
- Department of Ophthalmology, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Avinash V Mantravadi
- Department of Otolaryngology-Head and Neck Surgery, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Jonathan Ting
- Department of Otolaryngology-Head and Neck Surgery, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Taha Z Shipchandler
- Department of Otolaryngology-Head and Neck Surgery, Indiana University School of Medicine, Indianapolis, Indiana, USA
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Oliva S, Lorusso F, Scarano A, D’Amario M, Murmura G. The Treatment and Management of Oroantral Communications and Fistulas: A Systematic Review and Network Metanalysis. Dent J (Basel) 2024; 12:147. [PMID: 38786545 PMCID: PMC11120370 DOI: 10.3390/dj12050147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Revised: 04/17/2024] [Accepted: 05/07/2024] [Indexed: 05/25/2024] Open
Abstract
OBJECTIVES The aim of this work was to systematically review and carry out a statistical metanalysis to identify the best treatment for close oroantral communications and fistulas and to avoid the risk of recurrence. MATERIALS AND METHODS An electronic search was conducted on the MEDLINE database (Pubmed), Scopus, and Google scholar using the following keywords: "oro antral communication (OAC)" OR "oro antral fistula (OAF)" OR "antro-oral communication" OR "communication between maxillary sinus and oral cavity" OR "oro-sinusal communication" OR "oro-sinusal fistula" OR "sinus communication" OR "sinus fistula" OR "antral communication" AND "treatment" OR "management" OR "surgical treatment" OR "surgical interventions". This work was performed in accordance with the guidelines of PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses). After article screening, 9 RCTs (randomized controlled trials), comparing two or more techniques, were included in this review. RESULTS A statistically significant difference was detected in favor of the buccal fat pad compared to the buccal advancement flap and palatal rotational flap. CONCLUSIONS With the limitations of this study, the buccal fat pad showed the best results in terms of communication closure and reducing the risk of relapse.
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Affiliation(s)
- Stefano Oliva
- Department of Innovative Technologies in Medicine and Dentistry, University “G. d’Annunzio” of Chieti-Pescara, 66100 Chieti, Italy; (F.L.); (A.S.); (G.M.)
| | - Felice Lorusso
- Department of Innovative Technologies in Medicine and Dentistry, University “G. d’Annunzio” of Chieti-Pescara, 66100 Chieti, Italy; (F.L.); (A.S.); (G.M.)
| | - Antonio Scarano
- Department of Innovative Technologies in Medicine and Dentistry, University “G. d’Annunzio” of Chieti-Pescara, 66100 Chieti, Italy; (F.L.); (A.S.); (G.M.)
| | - Maurizio D’Amario
- Department of Life, Health and Environmental Sciences, University of L’Aquila, 67100 L’Aquila, Italy;
| | - Giovanna Murmura
- Department of Innovative Technologies in Medicine and Dentistry, University “G. d’Annunzio” of Chieti-Pescara, 66100 Chieti, Italy; (F.L.); (A.S.); (G.M.)
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Zhidkov R, Panin A, Drobyshev A, Demura T, Avraamova S, Aleksandrov P, Kolesnikova A, Darawsheh H, Turkina A, Redko N, Skakunov Y, Karpova E, Brago A, Tsitsiashvili A, Vasil’ev Y. Morphological Evaluation and Immunohistochemical Analysis of the Reparative Potential of the Buccal Fat Pad. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:567. [PMID: 38674213 PMCID: PMC11052332 DOI: 10.3390/medicina60040567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/01/2024] [Revised: 03/24/2024] [Accepted: 03/28/2024] [Indexed: 04/28/2024]
Abstract
Background and Objectives: There are many surgical techniques for oroantral communication treatment, one of which is the buccal fat pad. Of particular interest is the high reparative potential of the buccal fat pad, which may be contributed to by the presence of mesenchymal stem cells. The purpose of this work is to evaluate the reparative potential of BFP cells using morphological and immunohistochemical examination. Materials and Methods: 30 BFP samples were provided by the Clinic of Maxillofacial and Plastic Surgery of the Russian University of Medicine (Moscow, Russia) from 28 patients. Morphological examination of 30 BFP samples was performed at the Institute of Clinical Morphology and Digital Pathology of Sechenov University. Hematoxylin-eosin, Masson trichrome staining and immunohistochemical examination were performed to detect MSCs using primary antibodies CD133, CD44 and CD10. Results: During staining with hematoxylin-eosin and Masson's trichrome, we detected adipocytes of white adipose tissue united into lobules separated by connective tissue layers, a large number of vessels of different calibers, as well as the general capsule of BFP. The thin connective tissue layers contained neurovascular bundles. Statistical processing of the results of the IHC examination of the samples using the Mann-Whitney criterion revealed that the total number of samples in which the expression of CD44, CD10 and CD133 antigens was confirmed was statistically significantly higher than the number of samples where the expression was not detected (p < 0.05). Conclusions: During the morphological study of the BFP samples, we revealed statistically significant signs of MSCs presence (p < 0.05), including in the brown fat tissue, which proves the high reparative potential of this type of tissue and can make the BFP a choice option among other autogenous donor materials when eliminating OAC and other surgical interventions in the maxillofacial region.
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Affiliation(s)
- Roman Zhidkov
- Federal State Budgetary Educational Institution of Higher Education «ROSUNIMED» of the Ministry of Health of the Russian Federation, 119991 Moscow, Russia; (R.Z.); (A.P.); (A.D.); (A.T.)
| | - Andrew Panin
- Federal State Budgetary Educational Institution of Higher Education «ROSUNIMED» of the Ministry of Health of the Russian Federation, 119991 Moscow, Russia; (R.Z.); (A.P.); (A.D.); (A.T.)
| | - Aleksei Drobyshev
- Federal State Budgetary Educational Institution of Higher Education «ROSUNIMED» of the Ministry of Health of the Russian Federation, 119991 Moscow, Russia; (R.Z.); (A.P.); (A.D.); (A.T.)
| | - Tatiana Demura
- Institute of Clinical Morphology and Digital Pathology, I.M. Sechenov First Moscow State Medical University, 119435 Moscow, Russia; (T.D.); (S.A.); (P.A.); (A.K.)
| | - Sofya Avraamova
- Institute of Clinical Morphology and Digital Pathology, I.M. Sechenov First Moscow State Medical University, 119435 Moscow, Russia; (T.D.); (S.A.); (P.A.); (A.K.)
| | - Petr Aleksandrov
- Institute of Clinical Morphology and Digital Pathology, I.M. Sechenov First Moscow State Medical University, 119435 Moscow, Russia; (T.D.); (S.A.); (P.A.); (A.K.)
| | - Anastasia Kolesnikova
- Institute of Clinical Morphology and Digital Pathology, I.M. Sechenov First Moscow State Medical University, 119435 Moscow, Russia; (T.D.); (S.A.); (P.A.); (A.K.)
| | - Hadi Darawsheh
- N.V. Sklifosovskiy Institute of Clinical Medicine, I.M. Sechenov First Moscow State Medical University, 119435 Moscow, Russia;
| | - Anna Turkina
- E.V. Borovsky Institute of Dentistry, I.M. Sechenov First Moscow State Medical University, 119435 Moscow, Russia;
| | - Nicolai Redko
- Federal State Budgetary Educational Institution of Higher Education «ROSUNIMED» of the Ministry of Health of the Russian Federation, 119991 Moscow, Russia; (R.Z.); (A.P.); (A.D.); (A.T.)
| | - Yaroslav Skakunov
- Federal State Budgetary Educational Institution of Higher Education «ROSUNIMED» of the Ministry of Health of the Russian Federation, 119991 Moscow, Russia; (R.Z.); (A.P.); (A.D.); (A.T.)
| | - Elena Karpova
- Federal State Budgetary Educational Institution of Higher Education, Pirogov Russian National Research Medical University of the Ministry of Health of the Russian Federation, 119991 Moscow, Russia;
| | - Anzhela Brago
- Department of Propedeutics of Dental Diseases, Medical Institute, Peoples’ Friendship University of Russia Named after Patrice Lumumba, 117198 Moscow, Russia;
| | - Aleksandr Tsitsiashvili
- Federal State Budgetary Educational Institution of Higher Education «ROSUNIMED» of the Ministry of Health of the Russian Federation, 119991 Moscow, Russia; (R.Z.); (A.P.); (A.D.); (A.T.)
| | - Yuriy Vasil’ev
- N.V. Sklifosovskiy Institute of Clinical Medicine, I.M. Sechenov First Moscow State Medical University, 119435 Moscow, Russia;
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Natsir Kalla DS, Alkaabi S, Fauzi A, Tajrin A, Nurrahma R, Müller WEG, Schröder HC, Wang X, Forouzanfar T, Helder MN, Ruslin M. Microfragmented Fat and Biphasic Calcium Phosphates for Alveolar Cleft Repair: Protocol for a Prospective, Nonblinded, First-in-Human Clinical Study. JMIR Res Protoc 2024; 13:e42371. [PMID: 38224475 PMCID: PMC10825761 DOI: 10.2196/42371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Revised: 02/08/2023] [Accepted: 02/09/2023] [Indexed: 01/16/2024] Open
Abstract
BACKGROUND Biphasic calcium phosphates (BCP) may serve as off-the-shelf alternatives for iliac crest-derived autologous bone in alveolar cleft reconstructions. To add osteoinductivity to the osteoconductive BCPs to achieve similar regenerative capacity as autologous bone, a locally harvested buccal fat pad will be mechanically fractionated to generate microfragmented fat (MFAT), which has been shown to have high regenerative capacity due to high pericyte and mesenchymal stem cell content and a preserved perivascular niche. OBJECTIVE Our primary objectives will be to assess the feasibility and safety of the BCP-MFAT combination. The secondary objective will be efficacy, which will be evaluated using radiographic imaging and histological and histomorphometric evaluation of biopsies taken 6 months postoperatively, concomitant with dental implant placement. METHODS Eight patients with alveolar cleft (≥15 years) will be included in this prospective, nonblinded, first-in-human clinical study. MFAT will be prepared intraoperatively from the patient's own buccal fat pad. Regular blood tests and physical examinations will be conducted, and any adverse events (AEs) or serious EAs (SAEs) will be meticulously recorded. Radiographic imaging will be performed prior to surgery and at regular intervals after reconstruction of the alveolar cleft with the BCP-MFAT combination. Biopsies obtained after 6 months with a trephine drill used to prepare the implantation site will be assessed with histological and histomorphometric analyses after methylmethacrylate embedding and sectioning. RESULTS The primary outcome parameter will be safety after 6 months' follow-up, as monitored closely using possible occurrences of SAEs based on radiographic imaging, blood tests, and physical examinations. For efficacy, radiographic imaging will be used for clinical grading of the bone construct using the Bergland scale. In addition, bone parameters such as bone volume, osteoid volume, graft volume, and number of osteoclasts will be histomorphometrically quantified. Recruitment started in November 2019, and the trial is currently in the follow-up stage. This protocol's current version is 1.0, dated September 15, 2019. CONCLUSIONS In this first-in-human study, not only safety but also the histologically and radiographically assessed regenerative potential of the BCP-MFAT combination will be evaluated in an alveolar cleft model. When an SAE occurs, it will be concluded that the BCP-MFAT combination is not yet safe in the current setting. Regarding AEs, if they do not occur at a higher frequency than that in patients treated with standard care (autologous bone) or can be resolved by noninvasive conventional methods (eg, with analgesics or antibiotics), the BCP-MFAT combination will be considered safe. In all other cases, the BCP-MFAT combination will not yet be considered safe. TRIAL REGISTRATION Indonesia Clinical Trial Registry INA-EW74C1N; https://tinyurl.com/28tnrr64. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/42371.
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Affiliation(s)
- Diandra Sabrina Natsir Kalla
- Department of Oral and Maxillofacial Surgery/Oral Pathology, Amsterdam University Medical Centers and Academic Centre for Dentistry Amsterdam, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, Netherlands
- Department of Biochemistry, Faculty of Medicine, Hasanuddin University, Makassar, Indonesia
| | - Salem Alkaabi
- Department of Oral and Maxillofacial Surgery/Oral Pathology, Amsterdam University Medical Centers and Academic Centre for Dentistry Amsterdam, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, Netherlands
- Department of Oral and Maxillofacial Surgery, Fujairah Hospital, Ministry of Health, Fujairah, United Arab Emirates
| | - Abul Fauzi
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Hasanuddin University, Makassar, Indonesia
| | - Andi Tajrin
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Hasanuddin University, Makassar, Indonesia
| | - Rifaat Nurrahma
- Department of Oral and Maxillofacial Surgery/Oral Pathology, Amsterdam University Medical Centers and Academic Centre for Dentistry Amsterdam, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, Netherlands
- Department of Prosthodontics, Faculty of Dentistry, Hasanuddin University, Makassar, Indonesia
| | - Werner E G Müller
- ERC Advanced Investigator Grant Research Group at the Institute for Physiological Chemistry, University Medical Center of the Johannes Gutenberg University, Mainz, Germany
| | - Heinz C Schröder
- ERC Advanced Investigator Grant Research Group at the Institute for Physiological Chemistry, University Medical Center of the Johannes Gutenberg University, Mainz, Germany
| | - Xiaohong Wang
- ERC Advanced Investigator Grant Research Group at the Institute for Physiological Chemistry, University Medical Center of the Johannes Gutenberg University, Mainz, Germany
| | - Tymour Forouzanfar
- Department of Oral and Maxillofacial Surgery/Oral Pathology, Amsterdam University Medical Centers and Academic Centre for Dentistry Amsterdam, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, Netherlands
- Department of Oral and Maxillofacial Surgery, Leiden University Medical Centre, Leiden, Netherlands
| | - Marco N Helder
- Department of Oral and Maxillofacial Surgery/Oral Pathology, Amsterdam University Medical Centers and Academic Centre for Dentistry Amsterdam, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, Netherlands
| | - Muhammad Ruslin
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Hasanuddin University, Makassar, Indonesia
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Lee DW, Kim H, Si-Hyong J, Byeon JY, Choi HJ. Successful reconstruction using a buccal fat pad flap in misdiagnosed buccinators intramuscular synovial sarcoma: A case report. Medicine (Baltimore) 2023; 102:e35966. [PMID: 37960742 PMCID: PMC10637528 DOI: 10.1097/md.0000000000035966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2023] [Accepted: 10/16/2023] [Indexed: 11/15/2023] Open
Abstract
INTRODUCTION Synovial sarcoma (SS) is a subtype of soft tissue sarcoma that primarily usually occurs in the lower extremities but rarely arises in the head and neck areas, including the oral cavity. Due to its variable presentation and similarity to benign masses in terms of age at onset, growth rate, and favorable outcomes, SS is often misdiagnosed as a benign tumor. However, it is a malignant tumor. PATIENT CONCERNS We report the case of intramuscular SS in the oral cavity. Initially, the lesion was clinically suspected as a benign mass but was ultimately confirmed as malignant SS. DIAGNOSIS Although histopathological examination is the first step in diagnosing SS, molecular testing to confirm the presence of SYT-SSX fusion can provide a definitive diagnosis when the histopathology is inconclusive. In this patient as well, the postoperative pathological report confirmed the diagnosis of biphasic SS, and molecular testing revealed positive SYT/SSX fusion. THERAPEUTICS INTERVENTIONS Following the recommendation of multidisciplinary care system, a wide excision was performed including the buccinators muscle, and reconstruction was performed using a buccal fat pad flap to prevent cheek depression. OUTCOMES On the final pathologic report, SS was removed margin-free, and there were no metastatic lymph nodes. No evidence of cheek dimpling was observed, and follow-up neck CT showed no significant changes in the lymph nodes. As a result of observation up to several months after surgery, there were no functional and aesthetic complications. CONCLUSIONS We report a successful case of intramuscular SS resection, initially misdiagnosed as a benign mass, using a buccal fat pad flap. We also highlight the importance of correctly diagnosing SS, especially in the craniofacial region where it can be mistaken for benign masses.
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Affiliation(s)
- Da Woon Lee
- Department of Plastic and Reconstructive Surgery, College of Medicine, Soonchunhyang University Cheonan Hospital, Cheonan, Korea
| | - Hyun Kim
- Department of Plastic and Reconstructive Surgery, College of Medicine, Soonchunhyang University Cheonan Hospital, Cheonan, Korea
| | - Jang Si-Hyong
- Department of Pathology, College of Medicine, Soonchunhyang University Cheonan Hospital, Cheonan, Korea
| | - Je Yeon Byeon
- Department of Plastic and Reconstructive Surgery, College of Medicine, Soonchunhyang University Cheonan Hospital, Cheonan, Korea
| | - Hwan Jun Choi
- Department of Plastic and Reconstructive Surgery, College of Medicine, Soonchunhyang University Cheonan Hospital, Cheonan, Korea
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Nelke K, Morawska A, Błaszczyk B, Janeczek M, Pasicka E, Łukaszewski M, Żak K, Dobrzyński M. Anatomical and Surgical Implications of the Usage of Bichat Fat Pad in Oroantral Communication, Maxillary, Palatal, and Related Surgeries-Narrative Review. J Clin Med 2023; 12:4909. [PMID: 37568311 PMCID: PMC10419993 DOI: 10.3390/jcm12154909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2023] [Revised: 07/17/2023] [Accepted: 07/21/2023] [Indexed: 08/13/2023] Open
Abstract
The buccal fat pad, also called the Bichat's fat pad (BFP), is an encapsulated fat mass located in the cheek. This type of specialized fat mass can be used both as a pedicular or free graft in various surgeries and approaches. Due to its easy access from the oral cavity approach, it is commonly used for oroantral and palatal fistula closure. The knowledge of its anatomy and surrounding tissues plays a role in its mobilization and suturing onto the desired defect in the palatal or maxillary region. The BFP is mostly associated with the primary approach used for a fistula or bone surgery. Alternatively, the procedure can be performed with a single approach incision, which does not compromise the appearance or the function of the operating or adjacent areas. The most important inclusion criteria for BFP usage and surgical limitations are highlighted. The BFP is used for multiple purposes in reconstructive and oncology surgery and also has its use in esthetic and facial contouring procedures. The amount, volume, and shape of the BFP are mostly associated with the scope of their usage. The aim of the following narrative review is to present the surgical and anatomical implications of fat pads in maxillary and palatal surgeries.
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Affiliation(s)
- Kamil Nelke
- Maxillo-Facial Surgery Ward, EMC Hospital, Pilczycka 144, 54-144 Wrocław, Poland
- Academy of Applied Sciences, Health Department, Academy of Silesius in Wałbrzych, Zamkowa 4, 58-300 Wałbrzych, Poland;
| | - Alicja Morawska
- Department of Pediatric Dentistry and Preclinical Dentistry, Wrocław Medical University, Krakowska 26, 50-425 Wrocław, Poland; (A.M.); (M.D.)
| | - Bartłomiej Błaszczyk
- Student Scientific Circle of Experimental Dentistry and Biomaterial Research, Faculty of Dentistry, Wroclaw Medical University, Bujwida 44, 50-345 Wrocław, Poland
| | - Maciej Janeczek
- Department of Biostructure and Animal Physiology, Wrocław University of Environmental and Life Sciences, Kożuchowska 1, 51-631 Wrocław, Poland; (M.J.); (E.P.)
| | - Edyta Pasicka
- Department of Biostructure and Animal Physiology, Wrocław University of Environmental and Life Sciences, Kożuchowska 1, 51-631 Wrocław, Poland; (M.J.); (E.P.)
| | - Marceli Łukaszewski
- Department of Anaesthesiology and Intensive Care, Sokołowski Hospital, Sokołowskiego 4, 58-309 Wałbrzych, Poland;
| | - Krzysztof Żak
- Academy of Applied Sciences, Health Department, Academy of Silesius in Wałbrzych, Zamkowa 4, 58-300 Wałbrzych, Poland;
| | - Maciej Dobrzyński
- Department of Pediatric Dentistry and Preclinical Dentistry, Wrocław Medical University, Krakowska 26, 50-425 Wrocław, Poland; (A.M.); (M.D.)
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Arana-Fernández B, Santamaría-Gadea A, Almeida-Parra F, Mariño-Sánchez F. Oroantral Fistula Closure Using Double-Layered Flap: Greater Palatine Artery Flap and Buccal Fat Pad. Laryngoscope 2022. [PMID: 36367207 DOI: 10.1002/lary.30458] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Revised: 09/17/2022] [Accepted: 10/05/2022] [Indexed: 11/13/2022]
Abstract
A novel surgical technique based on a combined approach to oroantral fistula closure using a double-layered flap: greater palatine artery pedicled flap and buccal fat pad combination. Laryngoscope, 2023.
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Affiliation(s)
- Beatriz Arana-Fernández
- Hospital Ramón y Cajal, Unidad de Rinología y Cirugía de Base de Cráneo, Servicio de Otorrinolaringología, Madrid, Spain
| | - Alfonso Santamaría-Gadea
- Hospital Ramón y Cajal, Unidad de Rinología y Cirugía de Base de Cráneo, Servicio de Otorrinolaringología, Madrid, Spain
| | | | - Franklin Mariño-Sánchez
- Hospital Ramón y Cajal, Unidad de Rinología y Cirugía de Base de Cráneo, Servicio de Otorrinolaringología, Madrid, Spain.,Institut d'Investigacions Biomèdiques August Pi i Sunyer, Servicio de Otorrinolaringología, Barcelona, Spain
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9
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John RS, Solanki JA, Kanna VES, Ram H. Conventional fibrotomy and reconstruction with lateral thigh dermal fat pad in grade III oral submucous fibrosis patients: A case report and review of literature. Natl J Maxillofac Surg 2022; 13:S166-S169. [PMID: 36393940 PMCID: PMC9651222 DOI: 10.4103/njms.njms_167_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 02/02/2021] [Accepted: 02/26/2021] [Indexed: 01/25/2023] Open
Abstract
Oral submucous fibrosis is a chronic debilitating premalignant condition with progressive stiffening of oral mucosa ultimately ending in trismus most commonly from substance abuse. The most common etiological factor is the consumption of areca nut. Patients usually report to us when the mouth opening is almost nil. Various grafts have been used in the reconstruction of buccal defects after fiberotomy, the most popular being the buccal fat pad. We present the case of a 34-year-old man presenting with the complaint of reduced mouth opening and burning sensation in the mouth for 8 months. The patient is a poor candidate for buccal fat grafting as the patient body type being ectomorphic. The patient had a stigma of scar in the abdomen; hence, the possibility of an abdominal fat graft was out of the equation. Therefore, dermal fat is was harvested from the lateral thigh and reconstructed into the defect. The patient had a favorable outcome with good healing. Further studies are required to assess the quality, microscopic features of the adipose tissue, and the fate of dermal fat from the anterolateral thigh region.
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Affiliation(s)
- Rubin S. John
- Department of Oral and Maxillofacial Surgery, King George Medical University, Lucknow, Uttar Pradesh, India,Address for correspondence: Dr. Rubin S. John, #702, Akash Ganga Tower, New Hyderabad Colony, Hassanganj, Lucknow - 226 007, Uttar Pradesh, India. E-mail:
| | - Jaykishan A. Solanki
- Department of Oral and Maxillofacial Surgery, King George Medical University, Lucknow, Uttar Pradesh, India
| | - V. E. Shanthosh Kanna
- Department of Oral and Maxillofacial Surgery, King George Medical University, Lucknow, Uttar Pradesh, India
| | - Hari Ram
- Department of Oral and Maxillofacial Surgery, King George Medical University, Lucknow, Uttar Pradesh, India
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10
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Watabe Y, Shinagawa S, Shigematsu S. Surgery for Cystadenoma of the Retromolar Pad Area With Reconstruction Using a Buccal Fat Pad Flap: A Case Report. Cureus 2022; 14:e27314. [PMID: 36042995 PMCID: PMC9410783 DOI: 10.7759/cureus.27314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/26/2022] [Indexed: 11/05/2022] Open
Abstract
Salivary gland tumors can also occur rarely in the retromolar area, though common near the junction of hard and soft palate, labial mucosa, and buccal mucosa. Most salivary gland tumors in the retromolar pad area are malignant and should be excised. The cystadenoma is a rare, benign, salivary gland tumor. Importantly, incomplete resection of this tumor can lead to recurrence or cervical lymph node metastasis. We reported herein a case of cystadenoma arising in the right retromolar pad area in a 63-year-old male patient who underwent reconstruction using a buccal fat pad flap (BFPF) after the surgical removal of the tumor with a 10-mm margin left a defect with bone exposure. No evidence of recurrence or complication was found at the postoperative, three-year follow-up.
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11
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Cral WG. The Importance of Ultrasound in Excision of the Buccal Fat Pad. Aesthetic Plast Surg 2022; 46:1007-1008. [PMID: 34351510 DOI: 10.1007/s00266-021-02497-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Accepted: 07/21/2021] [Indexed: 10/20/2022]
Abstract
Partial excision of the buccal fat pad is a surgery indicated for different functional and aesthetic procedures. Although this surgery offers minimal risks, the ultrasound examination can provide security in performing the surgery, in addition to predicting preoperative anatomical variations and assisting in the treatment of postoperative complications. With the worldwide search for aesthetic procedures, concomitant with the development of imaging tests that help in different diagnoses and treatments, ultrasonography has become an excellent indication for planning oral fat pad surgeries.Level of Evidence V 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 .
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12
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Consorti G, Catarzi L, Messi M, Valassina D, Balercia P. New Tunneled Buccal Fat Pad Flap for Palatal Reconstruction. Craniomaxillofac Trauma Reconstr 2022; 15:90-94. [PMID: 35265283 PMCID: PMC8899347 DOI: 10.1177/1943387520988433] [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: 11/16/2022] Open
Abstract
In the palatal defects due to surgical resection, flap selection is very important for a correct reconstruction. Different methods have been suggested over the time, however the pedicled buccal fat pad is a simple, effective, reliable flap for reconstruction after palate tumor resection. The aim of the present study is to introduce a new surgical technique for palate reconstruction with pedicled buccal fat pad flap exposing the advantages. The Authors performed this procedure in 17 patients in order to treat medium-sized oncologic surgical defect of palate region in the period between 2016 and 2019. Complete wound healing after only 4 weeks without complication after 12 months follow-up was observed. This is the first cases series described with this new technique.
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Affiliation(s)
- Giuseppe Consorti
- Maxillo-Facial Surgery Unit, Azienda Ospedaliera Universitaria “Ospedali Riuniti di Ancona,” Umberto I, Ancona, Italy,Giuseppe Consorti, MD, Maxillo-Facial Surgery Unit, Azienda Ospedaliera Universitaria “Ospedali Riuniti di Ancona,” Umberto I, via Conca 71, Ancona 60126, Italy.
| | - Lisa Catarzi
- Maxillo-Facial Surgery, University of Siena, Siena, Italy
| | - Marco Messi
- Maxillo-Facial Surgery Unit, Azienda Ospedaliera Universitaria “Ospedali Riuniti di Ancona,” Umberto I, Ancona, Italy
| | - Davide Valassina
- Maxillo-Facial Surgery Unit, Azienda Ospedaliera Universitaria “Ospedali Riuniti di Ancona,” Umberto I, Ancona, Italy
| | - Paolo Balercia
- Maxillo-Facial Surgery Unit, Azienda Ospedaliera Universitaria “Ospedali Riuniti di Ancona,” Umberto I, Ancona, Italy
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13
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Seo GT, Beute JE, Shaari AL, Mundi N, Urken ML. A novel method of hard palate reconstruction utilizing a combination of the buccal fat pad and palatal island flap. Head Neck 2022; 44:1267-1271. [PMID: 35188301 DOI: 10.1002/hed.27008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Revised: 01/10/2022] [Accepted: 02/08/2022] [Indexed: 11/07/2022] Open
Abstract
The palatal island flap is reliable for single-staged reconstruction of select oral defects. However, fistula formation is a disruptive potential complication. The authors employed this technique in five patients and present a representative case of a 65-year-old female with a left-sided palatal salivary neoplasm. The patient underwent resection and was reconstructed utilizing a combination of the buccal fat pad and palatal island flap. Four of the five patients healed uneventfully. One patient experienced partial loss of the marginal zone of the palatal island flap which successfully granulated and did not lead to an oroantral fistula. The representative patient recovered uneventfully. At 2 weeks, she felt well, with no evidence of fistula. The anterior palate demonstrated early mucosalization. We present the novel, combined use of the palatal island flap and buccal fat pad flap to create a two-layer closure and describe its advantages for posterior palate reconstruction.
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Affiliation(s)
- Gabriella T Seo
- Thyroid, Head and Neck Cancer (THANC) Foundation, New York, New York, USA
| | - John E Beute
- Thyroid, Head and Neck Cancer (THANC) Foundation, New York, New York, USA
| | - Ariana L Shaari
- Thyroid, Head and Neck Cancer (THANC) Foundation, New York, New York, USA
| | - Neil Mundi
- Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Mark L Urken
- Thyroid, Head and Neck Cancer (THANC) Foundation, New York, New York, USA.,Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
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14
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Application of the Buccal Fat Pad in Oral Reconstruction: Covered With Collagen Membrane or Not? J Craniofac Surg 2022; 33:e559-e562. [PMID: 35075049 DOI: 10.1097/scs.0000000000008476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2021] [Accepted: 01/11/2022] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE To evaluate the clinical effectiveness of collagen membrane as biological dressing in protecting the covered buccal fat pad (BFP) from physical damage during postoperative healing phase in the reconstruction of oral soft tissue defect. METHODS A retrospective cohort study was performed in patients undergoing oral defects reconstruction using BFP. The predictor variable was the application of collagen membrane or not. The primary outcome variable was the wound healing. Other variables considered included age, gender, pain score, time taken for epithelialization, defect size and site. Postoperative follow-up was done at 1 week, 3 weeks, 6 months, and 1 year. RESULTS Thirty patients in Zhuhai People's Hospital were selected and randomly divided in 2 groups. Group I patients were reconstructed using BFP alone, whereas collagen membrane was used as a covering over BFP in group II patients. In group I, 4 patients developed dehiscence 1-week postoperative, and underwent Infection with food lodgment along with another 1 patient at 3-week follow-up, whereas none of the group II patients developed dehiscence or infection. Pain score was lesser in group II patients as compared to group I. Time taken for epithelialization was about 3 weeks in both groups. CONCLUSIONS Combined application of collagen membrane protects the covered BFP from masticatory physical damage and food lodgment, which reduces infection and graft loss. It is worthy of consideration as an effective method for the reconstruction of selected moderate-sized oral defects, especially in larger size or at distant location.
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15
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Pereira D, Sequeira I. A Scarless Healing Tale: Comparing Homeostasis and Wound Healing of Oral Mucosa With Skin and Oesophagus. Front Cell Dev Biol 2021; 9:682143. [PMID: 34381771 PMCID: PMC8350526 DOI: 10.3389/fcell.2021.682143] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Accepted: 06/24/2021] [Indexed: 12/14/2022] Open
Abstract
Epithelial tissues are the most rapidly dividing tissues in the body, holding a natural ability for renewal and regeneration. This ability is crucial for survival as epithelia are essential to provide the ultimate barrier against the external environment, protecting the underlying tissues. Tissue stem and progenitor cells are responsible for self-renewal and repair during homeostasis and following injury. Upon wounding, epithelial tissues undergo different phases of haemostasis, inflammation, proliferation and remodelling, often resulting in fibrosis and scarring. In this review, we explore the phenotypic differences between the skin, the oesophagus and the oral mucosa. We discuss the plasticity of these epithelial stem cells and contribution of different fibroblast subpopulations for tissue regeneration and wound healing. While these epithelial tissues share global mechanisms of stem cell behaviour for tissue renewal and regeneration, the oral mucosa is known for its outstanding healing potential with minimal scarring. We aim to provide an updated review of recent studies that combined cell therapy with bioengineering exporting the unique scarless properties of the oral mucosa to improve skin and oesophageal wound healing and to reduce fibrotic tissue formation. These advances open new avenues toward the ultimate goal of achieving scarless wound healing.
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Affiliation(s)
| | - Inês Sequeira
- Institute of Dentistry, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
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16
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Lee HW, Hong SO, Bae H, Shin Y, Jee YJ. The use of a pedicled buccal fat pad for reconstruction of posterior mandibular defects. Maxillofac Plast Reconstr Surg 2021; 43:23. [PMID: 34228210 PMCID: PMC8260705 DOI: 10.1186/s40902-021-00306-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Accepted: 06/15/2021] [Indexed: 11/15/2022] Open
Abstract
Background The pedicled buccal fat pad has been used for a long time to reconstruct oral defects due to its ease of flap formation and few complications. Many cases related to reconstruction of defects in the maxilla, such as closing the oroantral fistula, have been reported, but cases related to the reconstruction of defects in the mandible are limited. Under adequate anterior traction, pedicled buccal fat pad can be a reliable and effective method for reconstruction of surgical defects in the posterior mandible. Case presentation This study describes two cases of reconstruction of surgical oral defects in the posterior mandible, all of which were covered by a pedicled buccal fat pad. The size of the flap was sufficient to perfectly close the defect without any tension. Photographic and radiologic imaging showed successful closure of the defects and no problems were noted in the treated area. Conclusion In conclusion, the pedicled buccal fat pad graft is a convenient and reliable method for the reconstruction of surgical defects on the posterior mandible.
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Affiliation(s)
- Hyen Woo Lee
- Department of Oral and Maxillofacial Surgery, Kyung Hee University Dental Hospital at Gangdong, #892 Dongnam-ro, Gangdong-gu, Seoul, 05278, Republic of Korea
| | - Sung Ok Hong
- Department of Oral and Maxillofacial Surgery, Kyung Hee University Dental Hospital at Gangdong, #892 Dongnam-ro, Gangdong-gu, Seoul, 05278, Republic of Korea
| | - Heeyeon Bae
- Department of Oral and Maxillofacial Surgery, Kyung Hee University Dental Hospital at Gangdong, #892 Dongnam-ro, Gangdong-gu, Seoul, 05278, Republic of Korea
| | - Youngjin Shin
- Department of Oral and Maxillofacial Surgery, Kyung Hee University Dental Hospital at Gangdong, #892 Dongnam-ro, Gangdong-gu, Seoul, 05278, Republic of Korea
| | - Yu-Jin Jee
- Department of Oral and Maxillofacial Surgery, Kyung Hee University Dental Hospital at Gangdong, #892 Dongnam-ro, Gangdong-gu, Seoul, 05278, Republic of Korea. .,Department of Oral and Maxillofacial Surgery, College of Dentistry, School of Dentistry, Kyung Hee University, Seoul, Republic of Korea.
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17
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Nishikubo S, Matsuda H, Watanabe S, Tamura H, Tonogi M. Reconstruction of maxillary palatal defects after partial maxillectomy using a pedicled buccal fat pad and a nasolabial flap. Clin Case Rep 2021; 9:e04442. [PMID: 34295479 PMCID: PMC8287315 DOI: 10.1002/ccr3.4442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Revised: 05/13/2021] [Accepted: 05/16/2021] [Indexed: 11/25/2022] Open
Abstract
The novelty of this procedure is the reconstruction of a maxillary palatal defect with two pedicled flaps: a pedicled buccal fat pad and a nasolabial flap. This use of combination flaps makes the surgery simple, short, and useful for a wide defect.The novelty of this procedure is the reconstruction of a maxillary palatal defect with two pedicled flaps: a pedicled buccal fat pad and a nasolabial flap. This use of combination flaps makes the surgery simple, short, and useful for a wide defect.
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Affiliation(s)
- Shuichi Nishikubo
- First Department of Oral and Maxillofacial SurgeryNihon University School of DentistryTokyoJapan
| | | | - Shinya Watanabe
- Oral and Maxillofacial SurgeryKameda General HospitalChibaJapan
| | | | - Morio Tonogi
- First Department of Oral and Maxillofacial SurgeryNihon University School of DentistryTokyoJapan
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18
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Yang CS, Huang YL, Chen CB, Deng CY, Liu YT, Huang PHP, Chang KC. Aging Process of Lateral Facial Fat Compartments: A Retrospective Study. Aesthet Surg J 2021; 41:NP247-NP254. [PMID: 33649752 DOI: 10.1093/asj/sjaa340] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Since 2007, when the anatomy of facial fat compartment was described, an increasing number of studies on the aging process of the compartment of cadavers has emerged. OBJECTIVES The authors evaluated the aging changes of lateral facial fat compartments on the same person. METHODS Sixty-three patients were included in this retrospective study. All patients had magnetic resonance imaging scans with at least 4 years apart. The authors targeted the fat compartments of the superficial temporal, subcutaneous temporal, and buccal fat pad, comparing the data on different time points. RESULTS The thickness of the subcutaneous temporal fat did not change significantly. The 3 diameters of the superficial temporal fat compartment all became thinner on the axial view (P < 0.05). On the sagittal view, the superficial temporal fat elongated from 38.89 mm to 43.74 mm (P < 0.05). The buccal fat compartment also lengthened from 68.73 mm to 74.39 mm (P < 0.05) and had a positive correlation with follow-up duration only. CONCLUSIONS The study revealed the fat compartment change on the same person with time. The temporal hollow mainly originates from the thinner part of the superficial temporal fat. The descending of the buccal fat pad aggravates the labiomandibular fold. By understanding the aging process more fully, we can rejuvenate our patients more naturally.
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Affiliation(s)
- Ching-Sheng Yang
- Department of Dermatology, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Yau-Li Huang
- Department of Dermatology, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Chun-Bing Chen
- Department of Dermatology, Chang Gung Memorial Hospital, Keelung, Taiwan
| | - Chih-Ying Deng
- Department of Dermatology, Chang Gung Memorial Hospital, Linkou, Taiwan
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19
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Consorti G, Catarzi L, Valassina D, Balercia P. Palatal reconstruction with tunnellized Bichat fat pad flap after tumour resection. Minerva Dent Oral Sci 2021; 71:168-173. [PMID: 33929131 DOI: 10.23736/s2724-6329.21.04459-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Reconstruction of palate defects following tumour ablative surgery can be a challenging problem. Different methods have been suggested over the time for the reconstruction of postoperative palatal defects. Since the first report of the Bichat fat pad flap in1977, it has become one of the most commonly used flaps for the reconstruction of palate after tumour excision. We report our results using the tunnellized Bichat fat pad (BFP) flap for 23 cases of palate reconstruction after minor salivary glands tumour excision. METHODS The Authors performed a tunnellized bichat fat pad flap for primary reconstruction of small- medium-sized surgical defects of the palate in 23 patients suffering from minor salivary glands palatal tumors in the period between 2016 and 2019. Each case was reviewed for primary pathologic findings, wound healing, postoperative complications. RESULTS All 23 tunnellized BFP procedures showed excellent recovery and uneventful follow-up. With this technique after 12 months follow-up complete wound healing after only 4 weeks without complication was observed. CONCLUSIONS The tunnellized BFP flap is useful, easy, and uncomplicated new alternative method for primary reconstruction of small to medium-sized palatal surgical defects, that can be performed with a very low morbidity. Submucosal tunnel for the pedicle passage introduced by the Authors adds some advantages in final outcomes with less discomfort for the patients, proving to be a technique able to adds itself to surgical reconstructive technique available today.
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Affiliation(s)
- Giuseppe Consorti
- Department of Maxillo-Facial Surgery, Azienda Universitaria Ospedaliera Ospedali Riuniti Umberto I, Ancona, Italy -
| | - Lisa Catarzi
- Maxillo-Facial Surgery Residency, Azienda Ospedaliera Universitaria Senese, Università degli Studi di Siena, Siena, Italy
| | - Davide Valassina
- Department of Maxillo-Facial Surgery, Azienda Universitaria Ospedaliera Ospedali Riuniti Umberto I, Ancona, Italy
| | - Paolo Balercia
- Department of Maxillo-Facial Surgery, Azienda Universitaria Ospedaliera Ospedali Riuniti Umberto I, Ancona, Italy
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20
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Yoon JH, Park YW, Kim SG. Titanium mesh and pedicled buccal fat pad for the reconstruction of maxillary defect: case report. Maxillofac Plast Reconstr Surg 2021; 43:10. [PMID: 33730262 PMCID: PMC7969670 DOI: 10.1186/s40902-021-00295-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2020] [Accepted: 03/07/2021] [Indexed: 11/21/2022] Open
Abstract
Background Pedicled buccal fat pad (PBFP) has been used for the reconstruction of small-sized maxillary defects but cannot be used without hard tissue support on the defect larger than 4 cm × 4 cm × 3 cm. Case presentation A 64-year-old man had a history of squamous cell carcinoma of the left maxilla. After removal of the posterior maxilla, a complex bone defect (size, 5 cm × 4 cm × 3 cm) was immediately reconstructed using PBFP combined with a titanium mesh. A pinpoint fistula was found in the left palatal region 1 month after the surgery and was treated with a palatal sliding flap. There were no further complications during the follow-up. Conclusion The present technique demonstrated that PBFP combined with a titanium mesh could be used for the reconstruction of complex maxillary defect (size, 5 cm × 4 cm × 3 cm) without additional bone graft.
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Affiliation(s)
- Joo-Hyung Yoon
- Department of Oral and Maxillofacial Surgery, College of Dentistry, Gangneung-Wonju National University, Jukheon gil 7, Gangneung, Gangwondo, 25457, Republic of Korea
| | - Young-Wook Park
- Department of Oral and Maxillofacial Surgery, College of Dentistry, Gangneung-Wonju National University, Jukheon gil 7, Gangneung, Gangwondo, 25457, Republic of Korea
| | - Seong-Gon Kim
- Department of Oral and Maxillofacial Surgery, College of Dentistry, Gangneung-Wonju National University, Jukheon gil 7, Gangneung, Gangwondo, 25457, Republic of Korea.
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21
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Abstract
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.
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Affiliation(s)
- Fairouz Chouikh
- Clinique de Chirurgie Maxillo-faciale du Grand Montréal, 1055 Beaver Hall, Suite 301, Montréal, Québec H2Z 1S5, Canada
| | - Eric J Dierks
- Head and Neck Surgical Associates, 1849 Northwest Kearney Street, #300, Portland, OR 97209, USA.
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22
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Rikhotso RE. Use of buccal fat pad as a pedicled graft for maxillary reconstruction in a 6-months old with juvenile aggressive ossifying fibroma. ORAL AND MAXILLOFACIAL SURGERY CASES 2020. [DOI: 10.1016/j.omsc.2020.100156] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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23
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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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24
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Park YW. Cleft missions of the Korean Association of Maxillofacial Plastic and Reconstructive Surgeons. Maxillofac Plast Reconstr Surg 2019; 41:37. [PMID: 31592437 PMCID: PMC6757076 DOI: 10.1186/s40902-019-0219-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Accepted: 08/19/2019] [Indexed: 11/30/2022] Open
Affiliation(s)
- Young-Wook Park
- Department of Oral and Maxillofacial Surgery, College of Dentistry, Gangneung-Wonju National University, Gangneung, Republic of Korea
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25
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Three-Layered Closure of Persistent Oroantral Fistula Using Chin Graft, Buccal Fat Pad, and Buccal Advancement Flap: A Case Report with Review of Literature. Case Rep Dent 2019; 2019:8450749. [PMID: 31485358 PMCID: PMC6710802 DOI: 10.1155/2019/8450749] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Revised: 07/20/2019] [Accepted: 07/30/2019] [Indexed: 11/30/2022] Open
Abstract
Various techniques have been used for the repair of oroantral fistula (OAF) but majority of them have focused on the soft tissue closure alone, and most of the time, the osseous floor of the sinus was ignored. Existing literature supports that bone grafts supported by Buccal Fat Pad (BFP) heal well without undergoing significant resorption and necrosis. Through this case report, we wish to elaborate on the clinical success of using BFP and autogenous chin graft for simultaneous reconstruction of a large long-standing oroantral fistula with underlying osseous defect. The combination technique can prove beneficial for osseous regeneration of sinus floor and improve chances for future implant prosthetic rehabilitation.
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26
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Parvini P, Obreja K, Begic A, Schwarz F, Becker J, Sader R, Salti L. Decision-making in closure of oroantral communication and fistula. Int J Implant Dent 2019; 5:13. [PMID: 30931487 PMCID: PMC6441669 DOI: 10.1186/s40729-019-0165-7] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Accepted: 02/05/2019] [Indexed: 11/18/2022] Open
Abstract
After removal of a dental implant or extraction of a tooth in the upper jaw, the closure of an oroantral fistula (OAF) or oroantral communication (OAC) can be a difficult problem confronting the dentist and surgeon working in the oral and maxillofacial region. Oroantral communication (OAC) acts as a pathological pathway for bacteria and can cause infection of the antrum, which further obstructs the healing process as it is an unnatural communication between the oral cavity and the maxillary sinus. There are different ways to perform the surgical closure of the OAC. The decision-making in closure of oroantral communication and fistula is influenced by many factors. Consequently, it requires a combination of knowledge, experience, and information gathering. Previous narrative research has focused on assessments and comparisons of various surgical techniques for the closure of OAC/OAF. Thus, the decision-making process has not yet been described comprehensively. The present study aims to illustrate all the factors that have to be considered in the management of OACs and OAFs that determine optimal treatment.
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Affiliation(s)
- Puria Parvini
- Department of Oral Surgery and Implantology, Carolinum, Goethe University, Frankfurt, Germany
| | - Karina Obreja
- Department of Oral Surgery and Implantology, Carolinum, Goethe University, Frankfurt, Germany.
| | - Amira Begic
- Department of Oral Surgery and Implantology, Carolinum, Goethe University, Frankfurt, Germany
| | - Frank Schwarz
- Department of Oral Surgery and Implantology, Carolinum, Goethe University, Frankfurt, Germany.,Department of Oral Surgery, Universitätsklinikum Düsseldorf, Düsseldorf, Germany
| | - Jürgen Becker
- Department of Oral Surgery, Universitätsklinikum Düsseldorf, Düsseldorf, Germany
| | - Robert Sader
- Department for Oral, Cranio-Maxillofacial and Facial Plastic Surgery, Medical Center of the Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Loutfi Salti
- Department of Oral Surgery and Implantology, Carolinum, Goethe University, Frankfurt, Germany
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27
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Kim SM. Definition and management of odontogenic maxillary sinusitis. Maxillofac Plast Reconstr Surg 2019; 41:13. [PMID: 30989083 PMCID: PMC6439010 DOI: 10.1186/s40902-019-0196-2] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2019] [Accepted: 02/22/2019] [Indexed: 02/07/2023] Open
Abstract
Background Maxillary sinusitis of odontogenic origin, also known as maxillary sinusitis of dental origin or odontogenic maxillary sinusitis (OMS), is a common disease in dental, otorhinolaryngologic, allergic, general, and maxillofacial contexts. Despite being a well-known disease entity, many cases are referred to otorhinolaryngologists by both doctors and dentists. Thus, early detection and initial diagnosis often fail to detect its odontogenic origin. Main body We searched recent databases including MEDLINE (PubMed), Embase, and the Cochrane Library using keyword combinations of "odontogenic," "odontogenic infection," "dental origin," "tooth origin," "sinusitis," "maxillary sinus," "maxillary sinusitis," "odontogenic maxillary sinusitis," "Caldwell Luc Procedure (CLP)," "rhinosinusitis," "functional endoscopic sinus surgery (FESS)," "modified endoscopy-assisted maxillary sinus surgery (MESS)," and "paranasal sinus." Aside from the PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) trial, there have been very few randomized controlled trials examining OMS. We summarized the resulting data based on our diverse clinical experiences. Conclusion To promote the most efficient and accurate management of OMS, this article summarizes the clinical features of rhinosinusitis compared with OMS and the pathogenesis, microbiology, diagnosis, and results of prompt consolidated management of OMS that prevent anticipated complications. The true origin of odontogenic infections is also reviewed.
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Affiliation(s)
- Soung Min Kim
- Oral and Maxillofacial Microvascular Reconstruction LAB, Ghana Health Service, Brong Ahafo Regional Hospital, P.O. Box 27, Sunyani, Brong Ahafo Ghana.,2Department of Oral and Maxillofacial Surgery, Dental Research Institute, School of Dentistry, Seoul National University, 101 Daehak-ro, Jongno-gu, Seoul, 110-768 South Korea
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28
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Ultrasonic Piezoelectric Bone Surgery Combined With Leukocyte and Platelet-Rich Fibrin and Pedicled Buccal Fat Pad Flap in Denosumab-Related Osteonecrosis of the Jaw. J Craniofac Surg 2019; 30:e434-e436. [DOI: 10.1097/scs.0000000000005472] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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29
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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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30
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Al-Juboori MJ, Al-Attas MA, Magno Filho LC. Treatment of chronic oroantral fistula with platelet-rich fibrin clot and collagen membrane: a case report. Clin Cosmet Investig Dent 2018; 10:245-249. [PMID: 30519116 PMCID: PMC6233470 DOI: 10.2147/ccide.s179751] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
An oroantral fistula is a complication of the maxillary posterior teeth that can occur after a tooth extraction that affects the maxillary sinus. Improper management may lead to a persistent fistula, which may become chronic. In this case report, platelet-rich fibrin (PRF) was used with a collagen membrane to close a chronic fistula in a single patient. A flap was raised, the oroantral fistula tract was eliminated, and the opening was closed with a resorbable membrane as a first layer and covered with a PRF clot as a second layer. The flap was closed, and the patient was followed up for suture removal and confirmation of complete soft tissue closure. The postsurgical sign and symptoms of the patient disappeared in the first week; complete tissue healing was detected within 2 weeks, and tissue hypertrophy was observed in the fourth week. The use of PRF may have advantages for soft-tissue healing and for accelerating soft tissue formation by subsequent hypertrophy.
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Affiliation(s)
| | - Mohammed Ahmed Al-Attas
- Prosthodontic and Dental Implant Department, Riyadh Dental Center, King Saud Medical City, Riyadh, Saudi Arabia
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31
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Ruslin M, Hajrah-Yusuf AS, Tajrin A, Lo LJ, Forouzanfar T. Utilization of pedicled buccal fat pads for coverage of the lateral relaxing wound: A review of literature and a case series of 15 patients. J Clin Exp Dent 2018; 10:e502-e506. [PMID: 29849977 PMCID: PMC5971070 DOI: 10.4317/jced.54797] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2018] [Accepted: 04/11/2018] [Indexed: 11/05/2022] Open
Abstract
Background The buccal fat pad (BFP) is an encapsulated mass originated from a specific fat tissue in various volume throughout the life of each person and BFP has been used in various surgeries as a source of useful graft material due to its easy accessibility and rich vascularization. Case Report This report describes fifteen patients who were treated with buccal fat pads (BFP) as a pedicled graft for lateral relaxing wound closure in primary cleft palate surgery. A review of relevant literature is also presented. Results All patients had a mean follow-up of 3.7 weeks with a minimum follow-up time of three weeks and a maximum follow-up of four weeks. All patients who had an uneventful immediate postoperative period showed signs of BFP epithelialization characterized by a yellowish tissue beginning in the first week and ending within 3-4 weeks after surgery. Conclusions The use of BFP for the small to medium-sized defects reconstruction in palatoplasty is a safe and reliable method with fast healing. Even older patients who would not be able to tolerate time-consuming flap reconstruction procedures had good results. Key words:Cleft palate, buccal fat pads, lateral relaxing wound.
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Affiliation(s)
- Muhammad Ruslin
- Department of Oral and Maxillofacial Surgery Faculty of Dentistry University of Hasanuddin, Makassar, Indonesia
| | - Andi S Hajrah-Yusuf
- Department of Oral and Maxillofacial Surgery Faculty of Dentistry University of Hasanuddin, Makassar, Indonesia
| | - Andi Tajrin
- Department of Oral and Maxillofacial Surgery Faculty of Dentistry University of Hasanuddin, Makassar, Indonesia
| | - Lun-Jou Lo
- Department of Oral and Maxillofacial Surgery Faculty of Dentistry University of Hasanuddin, Makassar, Indonesia
| | - Tymour Forouzanfar
- Department of Oral and Maxillofacial Surgery Faculty of Dentistry University of Hasanuddin, Makassar, Indonesia
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32
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Double-layer closure techniques after bone surgery of medication-related osteonecrosis of the jaw – A single center cohort study. J Craniomaxillofac Surg 2018; 46:815-824. [DOI: 10.1016/j.jcms.2018.03.005] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2017] [Revised: 02/14/2018] [Accepted: 03/07/2018] [Indexed: 11/27/2022] Open
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33
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Yang S, Jee YJ, Ryu DM. Reconstruction of large oroantral defects using a pedicled buccal fat pad. Maxillofac Plast Reconstr Surg 2018; 40:7. [PMID: 29637060 PMCID: PMC5884745 DOI: 10.1186/s40902-018-0144-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Accepted: 02/14/2018] [Indexed: 11/10/2022] Open
Abstract
Background Oroantral communicating defects, characterized by a connection between the maxillary sinus and the oral cavity, are often induced by tooth extraction, removal of cysts and benign tumors, and resection of malignant tumors. The surgical defect may develop into an oroantral fistula, with resultant patient discomfort and chronic maxillary sinusitis. Small defects may close spontaneously; however, large oroantral defects generally require reconstruction. These large defects can be reconstructed with skin grafts and vascularized free flaps with or without bone graft. However, such surgical techniques are complex and technically difficult. A buccal fat pad is an effective, reliable, and straightforward material for reconstruction. Case presentation This report describes three cases of reconstruction of large oroantral defects, all of which were covered by a pedicled buccal fat pad. Follow-up photography and radiologic imaging showed successful closure of the oroantral defects. Furthermore, there were no operative site complications, and no patient reported postsurgical discomfort. Conclusion In conclusion, the use of the pedicled buccal fat pad is a reliable, safe, and successful method for the reconstruction of large oroantral defects.
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Affiliation(s)
- Sunin Yang
- Department of Oral and Maxillofacial Surgery, Kyung Hee University Dental Hospital at Gangdong, Kyung Hee University, #892 Dongnam-ro, Gangdong-gu, Seoul, 05278 Republic of Korea
| | - Yu-Jin Jee
- Department of Oral and Maxillofacial Surgery, Kyung Hee University Dental Hospital at Gangdong, Kyung Hee University, #892 Dongnam-ro, Gangdong-gu, Seoul, 05278 Republic of Korea
| | - Dong-Mok Ryu
- Department of Oral and Maxillofacial Surgery, Kyung Hee University Dental Hospital at Gangdong, Kyung Hee University, #892 Dongnam-ro, Gangdong-gu, Seoul, 05278 Republic of Korea
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34
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Shin SH, Seok H, Kim SG, Hong SD. Primary sinonasal mucosal melanoma simulated as cystic lesions: a case report. J Korean Assoc Oral Maxillofac Surg 2018. [PMID: 29535967 PMCID: PMC5845965 DOI: 10.5125/jkaoms.2018.44.1.29] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Sinonasal mucosal melanoma (SNMM) in the maxillary sinus is a rare disease condition. Compared to oral mucosal melanoma, SNMM has a bulky, exophytic, and polypoid appearance, is weakly pigmented, and associated with unspecific symptoms. Due to these features, SNMM in the maxillary sinus has been misdiagnosed as nasal polyps and chronic sinusitis. In this case report, we described SNMM occurring in the right maxillary sinus simulated as a cystic or benign lesion. Cortical bone thinning and expansion were observed around the mass. The excised soft mass was encapsulated and weakly pigmented. The mass was clearly excised and covered with a pedicled buccal fat pad graft. Diagnosis using immunohistochemistry with S-100 and homatropine methylbromide-45 (HMB-45) is critical for proper treatment.
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Affiliation(s)
- Sung-Ho Shin
- Department of Oral and Maxillofacial Surgery, College of Dentistry, Gangneung-Wonju National University, Gangneung, Korea
| | - Hyun Seok
- Department of Oral and Maxillofacial Surgery, College of Dentistry, Gangneung-Wonju National University, Gangneung, Korea.,Department of Oral and Maxillofacial Surgery, Chungbuk National University Hospital, Cheongju, Korea
| | - Seong-Gon Kim
- Department of Oral and Maxillofacial Surgery, College of Dentistry, Gangneung-Wonju National University, Gangneung, Korea
| | - Seong-Doo Hong
- Department of Oral Pathology, School of Dentistry, Seoul National University, Seoul, Korea
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35
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Jee YJ. The use of buccal fat pad in oral and maxillofacial reconstruction. J Korean Assoc Oral Maxillofac Surg 2017; 43:287. [PMID: 29142861 PMCID: PMC5685856 DOI: 10.5125/jkaoms.2017.43.5.287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Affiliation(s)
- Yu-Jin Jee
- Department of Oral and Maxillofacial Surgery, Kyung Hee University Dental Hospital at Gangdong, Seoul, Korea
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