Use of buccal fat pad to repair post-extraction peri-implant bone defects in the posterior maxilla. A preliminary prospective study

Intensity-modulated radiotherapy does not induce volumetric changes of the Bichat fat pad in nasopharyngeal cancer

PURPOSE

To evaluate morphological and functional changes in the Bichat fat pad (BFP) after curative concurrent chemoradiotherapy in nasopharyngeal cancer (NPC) patients.

METHODS

We retrospectively analyzed the volumetric, metabolic, and dosimetry parameters of BFPs in 7 NPC patients who underwent intensity-modulated radiotherapy (IMRT) between 2015 and 2020. Inclusion criteria were i) histologically confirmed diagnosis of NPC, ii) follow-up period of at least 12 months, iii) no history of previous irradiation or surgery in the maxillofacial area, and ìv) availability of pre- and posttreatment MRI and ¹⁸F‑FDG PET-CT performed in our Institution. All patients had stage III-IVA disease (n = 7) and received platinum-based chemotherapy. Planned doses in 30 daily fractions/5 days per week were 66 Gy (2.2 Gy/die 5 days/week) to the gross tumor volume, 66 Gy (2.1-2.2 Gy/die 5 days/week) to the gross nodal volume, 60 Gy (2 Gy/die 5 days week) to clinical target volume (CTV)1, and 54 Gy (1.8 Gy/die 5 days/week) to CTV2. All patients completed the planned radiotherapy course in a median time of 42 days (range 42-43). Relationships between BFP volumes and the following DVH parameters were evaluated: mean dose, maximum dose (Dmax), and percentage of BFP volume receiving more than 5 to 65 Gy (V5 to V65).

RESULTS

The pre-RT volumes of the left and right BFPs were 12.24 cc (range 6.51-20.01 cc) and 11.55 cc (range 5.78-17.53 cc), respectively. The mean volumes of left BFP_PRE and BFP_POST were 12.24 cc (range 6.51-20.01cc) and 13.85 cc (range 7.54-20.21 cc), respectively, with no significant statistical differences (P > 0.05). No statistically significant correlations were found between dosimetry features and BFP volumetric changes (all P > 0.05).

CONCLUSION

Our original results showed that chemoradiotherapy does not induce significant volumetric changes of the BFP. Further investigations are needed to evaluate the effects of higher radiation doses on BFP. This is the first real-world study on this issue.

Post-Operative Evaluation of the Intra-Oral Buccal Fat Pad Removal Technique: A Prospective Study

Background:

In recent years, the number of procedures for buccal fat pad removal has increased. In cases of thinning of the face, bite injuries or bruxism, partial removal of the corpuscle is performed, always taking into account facial harmonization.

Objective:

The aim of the present study was to demonstrate the post-operative procedure of the removal of the BFP by pain parameters, mouth opening and presence of edema. This longitudinal cohort study was registered in clinical trials and all participants had access to the informed consent form.

Methods:

Forty BFP removal surgeries were performed with the technique of intraoral access. After the bichectomy procedure, the individuals were followed for 4, 7, 10, 15, 30, and 90 days. Visual pain scale, mouth opening measurements and clinical visual assessment were performed at all times.

Results:

We observed that the presence of edema and limited mouth opening for about 15 days were the changes most commonly found in surgeries performed. The results showed a significant decrease in painful symptoms after 15 days, regarding mouth opening, the results showed a return to normal levels after 30 days (p <0.05), the presence of edema ceased after 15 days.

Conclusion:

We conclude that the BFP removal, when performed following a precise indication, properly and with the recommendations of post-operative care, followed correctly, promotes limitation in mouth opening and painful symptoms by 15 days.

The procedure is becoming a new area for the dental surgeon, who can perform the procedure safely, reliably and with aesthetic and therapeutic results.

Clinical Application of the Pedicled Buccal Fat Pad Flap in Immediate Reconstruction of Oral Tissue Defects in Oral Surgery

OBJECTIVE

The aim of this study was to present a new immediate reconstructive option for oral tissue defects with a pedicled buccal fat pad flap in oral surgery.

MATERIALS AND METHODS

Fifteen cases (10 males, 5 females; mean age: 50 years) suffering from oral tumor and attending the Affiliated Stomatology Hospital of Kunming Medical University were included in this study. All patients underwent immediate repair surgery involving a pedicled buccal fat pad graft in oral surgery, from July 2013 to August 2016.

RESULTS

All cases underwent uneventful healing with a surviving graft flap. The buccal fat pad healed in about 9 to 10 weeks and its uncovered surface became epithelialized with similar feature to the normal mucosa. At a follow-up of 3 months to 3 years, a good outcome was obtained with minimal malfunction and face deformity.

CONCLUSIONS

The pedicled buccal fat pad is ideal material for repair, and it is a viable option for immediate reconstruction of oral tissue defects in oral surgery.