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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 b...
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... flap [18]. Moreover, patients with damaged gingiva or those who received a previous closure operation cannot be indicated for the buccal advancement flap [18]. How- ever, BFP demonstrated high success rates, even in pre- viously operated cases [19]. The surgical procedure of BFP graft for the treatment of oroantral fistula is very simple (Fig. ...
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A systematic treatment plan of controlling chronic sinusitis, optimizing systemic health, and appropriate selection of surgical technique are essential requirements for successful closure of oroantral fistula. A systematic treatment plan of controlling chronic sinusitis, optimizing systemic health, and appropriate selection of surgical technique ar...
Citations
... This technique requires complete coverage by the oral mucosa. According to the literature, it seems that an uncovered BFP typically goes through full epithelialization within a period of four to six weeks [20]. ...
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.
... On the one hand, it has biological implementation at different ages of the patient, and on the other hand, it can be used in small and large reconstructive surgical procedures, especially in the maxillofacial region [3]. These include the repair of oral cavity defects after resective surgeries, closure of clefts of the hard and soft palate, treatment of peri-implantitis and repair of defects around dental implants, and the management of tooth recessions and OAC [4], as well as in the treatment of temporomandibular joint ankylosis [5][6][7][8][9], congenital pathologies, jawbone necrosis, and postoperative reconstructions in cancer patients [10]. ...
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.
... The average volume of the BFP was 10 mL, with an average weight of 10 g. [13] Tideman et al [14] reported that a BFP can cover defects of up to 6 × 5 × 3 cm, but the typical dimensions for coverage are considered to be approximately 4 × 4 × 3 cm. [15] This is because the flap should be sutured to the defect margin without tension to prevent necrosis. ...
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.
... Além de existir redes capilares ricas dentro da cápsula que envolvem a camada de gordura. Assim as arteríolas entram na cápsula por várias direções e se dividem em plexos capilares, sendo assim grande parte do sangue da camada de gordura drena para a veia facial (Kim, et al., 2017). ...
A comunicação buco antral pode estar associada aos traumas/iatrogenias, exodontias de molares superiores e em várias alterações patológicas, tornando assim muito frequente na Odontologia, sendo os principais sintomas relatados febre, dor e drenagem de secreção purulenta para a cavidade oral. O objetivo deste estudo é informar aos profissionais da saúde sobre a importância da bola de Bichat como uma potencial técnica cirúrgica para o fechamento de contato buco antral. A análise de artigos foi feita em inglês e português (Brasil) indexados nas bases de dados Pubmed, Scielo e Research Society and Development journal no período de 2014 até 2022, utilizando a estratégia de busca “Odontogenic sinusites; Regenerative potential of the Bichat fat; Oroantral fistulas closure using Bichat's fat; Bichectomia; Comunicação Bucosinusal”. O tecido adiposo da Bola de Bichat apresenta células-tronco mesenquimais (com a presença de uma subpopulação de multilinhagem resistente ao estresse) com um forte potencial proliferativo de osteoblastos sendo capazes de realizar diferenciação osteogênica, iniciando assim a produção de tecido mineralizado. Conclusão: Em vista disso, as vantagens da almofada de Bichat são: diminuição dos distúrbios e cicatrizes no vestíbulo em relação a técnica de deslizamento de retalhos, sendo considerado um procedimento de fácil execução e rápido, menos desconforto pré-operatório ao paciente, baixa morbidade, possibilidade de associar com outras técnicas cirúrgicas e possibilidade de ajustes após uma semana. Estando o insucesso da utilização do corpo adiposo bucal relacionado principalmente a tensão ou manipulação excessiva do tecido resultando em sua necrose.
... The BFP's other usage might include the coverage of small defects in the gingival tissues of posterior teeth and BFP reconstruction for the lateral pharyngeal wall and soft palate in cleft patients and cancer patients or defects from various trauma cases. Nevertheless, larger bone defects from fistulas, clefts, and tumor resection can be closed; however, in some cases, a combination of flaps can be used (like, e.g., the FAMM (facial artery muco-muscular flap) [35][36][37][38][39][40]. The second usage of the BFP is for TMJ reconstruction, orbital augmentation procedures, or even as a filler post-parotidectomy procedure or similar procedures [40][41][42][43][44][45][46][47][48]. ...
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.
... The buccal fat pad being advanced to thicken the peri-implant tissue is advantageous due to the rich vascularity of BFP and a tendency of the flap to induce epithelialization of the overlying tissue. 26 The figure 62 shows healing at approximately 20 months after initial surgery withthick and healthy soft tissue outcome over the facial aspects of the two extra-sinus zygomatic implants. ...
Secure anchorage of implants in the edentulous maxilla is an essential requirement for long term stability of the future
restoration. It is also a critical prerequisite for immediate loading of full arch prosthesis. Implant anchorage in the
the posterior maxilla is often challenged by poor quantity and quality of alveolar bone. A long and diverse history of
attempts in overcoming this very challenge can be evidenced in the literature.1
The maxillary sinus augmentation and
guided bone regeneration (GBR) offer solutions in improving both quality and quality of the bone for the foundation.2,
3, 4 However, this modality takes time and cannot meet the test for immediate load protocol. Alternative methods to
increase the residual bone volume prior to inserting the dental implants in this region includes the use of short implants,
tilted implants, and Le Fort I procedures in extreme situations.5
Using the zygomatic process, and the pterygomaxillary
suture/complex as a stable anchor had been an area of interest for the past two decades or more.6-9
The purpose of this case series is to explore, (1) the clinical advantages of utilizing the zygomatic process and the
pterygoid region of the maxilla to obtain secure anchoring, (2) the indications for use in immediate load protocol, (3) the
predictable and safe protocols known to date, and (4) to showcase three clinical examples of such approach. Known
complications and management strategies will also be discussed.
... Upper molars and premolars extraction is considered the most common etiology of OAF. [1][2][3] The aim of the OAF management is to repair the defect, restoring the integrity of the sinus and oral cavity and preventing sinus infections. Small fistulas (<5 mm) can heal spontaneously. ...
... However, OAF larger than 5 mm or those that have not been resolved within 3 months usually requires surgical treatment. 1,2 Choice of the technique for OAF closure depends on multiple factors such as the size, time of diagnosis, infection, height of the alveolar ridge, vestibular depth, further prosthetic treatment, and surgeon's experience. 1 Many techniques have been described for OAF closure, including local and soft tissue flaps, grafts, alloplastic materials, biologics, and metals. However, a rational decision-making process must be followed to choose the most adequate technique. ...
... 2,3 Its overall success rate for OAF closure is around 96.2%. 2 The principal limitation of BFP is the defect's size because defects measuring more than 4 Â 4 Â 3 cm have a high risk of dehiscence. 2 Our group previously described the use of a greater palatine artery (GPA) pedicled flap to repair nasal septal perforations with excellent results with minimal donor site morbidity. 4,5 This report presents a novel surgical technique for closure of large OAFs based on a combined endoscopic and transoral approach using a GPA pedicled flap and BFP. ...
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, 2022
... [2] The region of the lateral thigh defines a combined area of subcutaneous fat consisting of the lateral trochanteric area, the banana-form fold of the proximal posterior thigh, and the inferolateral buttock. Reconstruction with the buccal adipose tissue is always inferior when using an abdominal fat pad owing to physical properties, [3] and studies have revealed better physical property of lateral thigh fat compared to abdominal fat due to the increased amount of abdominal stem cells in the lateral thigh fat compared to other areas of harvest. [4] ...
... Although the buccal fat pad is most commonly used in the oral cavity, it lost its significance because of its fragility, and damage to the vascular pedicle during harvest may result in the loss of graft. [3] Abdominal fat grafting is usually considered as an alternative to buccal fat graft, but as the patient was hesitant for the same, the probability of lateral thigh graft was pondered upon. The lateral thigh flap is a large flap that can easily be obtained and no special positioning of the patient is required during its harvest as was observed by Pribaz et al. [6] Ozkan et al. used a free anterolateral thigh flap for reconstruction of buccal defects in 24 patients, of which three patients were of submucous fibrosis. ...
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.
... Knowledge of morphometric characteristics of the BFP is also useful in reconstructive procedures. Its vascularization and easy access make it a reliable tissue graft/ ap for reconstruction of maxillofacial and oral defects (congenital, pathological, or neoplasic), as well as interpositioning material for temporomandibular joint reconstruction [1,4,12,15,18,29]. ...
Purpose: To determine the volume of the buccal fat pad (BFP), and its relationship with the upper 2nd molar and the facial artery (FA).
Methods: A cross-sectional, observational study. Computed tomography was used to obtain 3D images to determine volume, length, and width. Distances from the 2nd molar to each extension, and the nearest distance to the FA.
Results: A total of 106 BFP (70 male) were included. The mean age was 51±21. The mean volume, length, and width were 13.8±5.4mL, 72.9±10.7mm, and 21.4±5.6mm, respectively. The BFP extends mainly cephalic and caudally from the second molar, reaching upto 8.5 cm and 32mL. The mean distance between the second molar and FA was 12.9mm, but as close as 3mm. The FA had a mean distance of 2.1mm to the nearest BFP extension, with 42.5% in intimate contact, and another 9.4% crossing the center of the masseter extension. There were no statistically significant differences between sexes.
Conclusions: The BFP has a dynamic shape with highly variable size and volume. Although removed for cosmetic procedures or reconstructive purposes, the FA is often at risk of damage during procedures due to its proximity. Procedures must be performed by highly trained medical professionals with anatomical knowledge of its morphometry and variability.
... According to a review of 12 studies, 89.1% of BFPF reconstructions had no associated adverse events, including infection, loss of graft, bleeding, fistula, dehiscence, and mouth opening limitation [20]. However, the BFPF has several shortcomings. ...
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.
