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Restoring the soft and hard tissue continuity following mandibular resection due to various causes is one of the most demanding aspects of head and neck reconstructive surgery. A vascularised flap does not always suffice for restoration, especially in the region of the Retromolar Trigone (RMT). This highlights the versatility of local flaps in restoring the RMT. The article aims to collect and evaluate data to present salient notes on various local flaps in terms of their features, techniques for flap elevation, reviews of studies, and the advantages and disadvantages to assist clinicians in choosing a viable flap for RMT reconstruction. In the pursuit of restoring the RMT, small and medium-sized defects can benefit from local flaps such as the Buccinator flap, Masseter flap, Facial Artery Myomuscular Flap (FAMM), tongue flap, palatal flap, and Buccal Fat Pad (BFP) or Bichat’s flap. Being in close proximity to the RMT, these local flaps offer a broad range of productivity and richness comparable to vascularised free flaps. The wide applicability and adaptability of local flaps make them an excellent choice for oral and maxillofacial surgeons, facilitating functional and aesthetic restorations with a high success rate.

Restoring the soft and hard tissue continuity following mandibular resection due to various causes is one of the most demanding aspects of head and neck reconstructive surgery. A vascularised flap does not always suffice for restoration, especially in the region of the Retromolar Trigone (RMT). This highlights the versatility of local flaps in restoring the RMT. The article aims to collect and evaluate data to present salient notes on various local flaps in terms of their features, techniques for flap elevation, reviews of studies, and the advantages and disadvantages to assist clinicians in choosing a viable flap for RMT reconstruction. In the pursuit of restoring the RMT, small and medium-sized defects can benefit from local flaps such as the Buccinator flap, Masseter flap, Facial Artery Myomuscular Flap (FAMM), tongue flap, palatal flap, and Buccal Fat Pad (BFP) or Bichat's flap. Being in close proximity to the RMT, these local flaps offer a broad range of productivity and richness comparable to vascularised free flaps. The wide applicability and adaptability of local flaps make them an excellent choice for oral and maxillofacial surgeons, facilitating functional and aesthetic restorations with a high success rate. [ABSTRACT FROM AUTHOR]

Buccal fat pads are biconvex adipose tissue bags that are uniquely found on both sides of the human face along the anterior border of the masseter muscles. Buccal fat pads are important determinants of facial appearance, facilitating gliding movements of facial masticatory and mimetic muscles. Buccal fad pad flaps are used for the repair of oral defects and as a rich and easily accessible source of mesenchymal stem cells. Here, we introduce the buccal fat pad anatomy and morphology and report its functions and applications for oral reconstructive surgery and for harvesting mesenchymal stem cells for clinical use. Future frontiers of buccal fat pad research are discussed. It is concluded that many biological and molecular aspects still need to be elucidated for the optimal application of buccal fat pad tissue in regenerative medicine. [ABSTRACT FROM AUTHOR]

Introduction: Owing to limitations of various flap procedures for the management of oral submucous fibrosis (OSMF), we tried to evaluate the outcome of the buccal fat pad (BFP) with collagen membrane as an alternative. Materials and methods: We performed the aforementioned technique on eight patients diagnosed with OSF who underwent management using the BFP with a collagen membrane. Results: We observed a significant mean gain in mouth opening of 5.29 ± 2.11 mm and a significant reduction in pain levels by 2.62 ± 1.05. No complication and recurrence were observed till fourmonth followup. Conclusion: It can be concluded that the BFP with a collagen membrane could be a viable alternative to other surgical procedures. However, our data should extrapolate with larger studies with longer followup.

ABSTRACT: Introduction: Owing to limitations of various flap procedures for the management of oral submucous fibrosis (OSMF), we tried to evaluate the outcome of the buccal fat pad (BFP) with collagen membrane as an alternative. Materials and methods: We performed the aforementioned technique on eight patients diagnosed with OSF who underwent management using the BFP with a collagen membrane. Results: We observed a significant mean gain in mouth opening of 5.29 ± 2.11 mm and a significant reduction in pain levels by 2.62 ± 1.05. No complication and recurrence were observed till fourmonth followup. Conclusion: It can be concluded that the BFP with a collagen membrane could be a viable alternative to other surgical procedures. However, our data should extrapolate with larger studies with longer followup. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

The buccal fat pad (BFP) is a specialized encapsulated adipose tissue, located intimately between the buccinator muscle and oral mucous membrane. A small perforation of buccinator muscle can lead to herniation of BFP into the oral cavity, which can be readily mistaken with a pathological entity. In general, the size of herniated BFP is larger than the perforation. The treatment options for BFP are excision or repositioning in its anatomical position if noticed early. This article reports two such cases presenting with herniation of the BFP, following trauma to buccal mucosa and its surgical management.

This study aimed to determine the most effective wavelength for the proliferation of Human Buccal Fat Pad Mesenchymal Stem Cells (BFPMSCs) in cell culture. These cells can be used for different purposes such as regenerative periodontal procedures. Materials and Methods: The wells containing BFPMSCs were subjected to laser irradiation at 635, 660, 808, and 980 nm wavelengths with 1, 1.5, 2.5, and 4 J/cm2 energy densities. Cell proliferation and viability were evaluated after 1, 3, and 5 days with the methyl thiazolyl tetrazolium (MTT) assay. Result: The proliferation rate of human Buccal Fat Pad Mesenchymal Cells (BFPMSCs) was increased on the first and third days at a wavelength of 808 nm and day five at a wavelength of 980 nm in comparison to the control group. Our findings distinguished that PBMT with 635, 660, 808, and 980 nm wavelengths increased the proliferation of BFPMSCs. Conclusion: The best laser radiation setting, which led to the highest proliferation rate of the cells, included a wavelength of 808 nm with 2.5 J/cm2 energy density. [ABSTRACT FROM AUTHOR]

Introduction: To develop a stem cell delivery model and improve the safety of stem cell transplantation for bone regeneration, this study aimed to determine the effects of stem cell sources, serum-free cell culture, and hydrogel cell encapsulation on the growth and osteogenic differentiation of mesenchymal stem cells (MSCs) from the oral cavity. Methods: The study groups were categorized according to stem cell sources into buccal fat pad adipose (hBFP-ADSCs) (Groups 1, 4, and 7), periodontal ligament (hPDLSCs) (Groups 2, 5, and 8), and dental pulp-derived stem cells (hDPSCs) (Groups 3, 6, and 9). MSCs from each source were isolated and expanded in three types of sera: fetal bovine serum (FBS) (Groups 1–3), human serum (HS) (Groups 4–6), and synthetic serum (SS) (StemPro™ MSC SFM) (Groups 7–9) for monolayer (m) and hydrogel cell encapsulation cultures (e). Following this, the morphology, expression of MSC cell surface antigens, growth, and osteogenic differentiation potential of the MSCs, and the expression of adhesion molecules were analyzed and compared. Results: SS decreased variations in the morphology and expression levels of cell surface antigens of MSCs from three cell sources (Groups 7m–9m). The levels of osteoblastic differentiation of the hPDLSCs and hBFP-ADSCs were increased in SS (Groups 8m and 7m) and the cell encapsulation model (Groups 1e, 4e, 7e–9e), but the promoting effects of SS were decreased in a cell encapsulation model (Groups 7e–9e). The expression levels of the alpha v beta 3 (ITG-αVβ3) and beta 1 (ITG-β1) integrins in the encapsulated cells in FBS (Group 1e) were higher than those in the SS (Group 7e). Conclusions: Human PDLSCs and BFP-ADSCs were the optimum stem cell source for stem cell encapsulation by using nanohydroxyapatite–calcium carbonate microcapsule–chitosan/collagen hydrogel in serum-free conditions. [ABSTRACT FROM AUTHOR]

Moderately advanced (stage III) and advanced (stage IV a & b) OSMF requires surgical intervention for management A number of options are available for reconstruction of post OSMF oral cavity defects. In our study we retrospectively compared buccal fat pad, nasolabial flap and platysma flap for reconstruction of the buccal mucosal defects. Patient records were obtained from the medical records section of the Institute and divided into three groups; group A (buccal fat pad), group B (nasolabial group) and group C (platysma flap). Maximal mouth opening and intercommisural distance were the primary outcomes. Kruskal Wallis test was used to test the mean difference between three groups. Mann–Whitney test was used for intergroup comparisons. Wilcoxon signed rank test was used to evaluate the mean difference in outcomes at each follow up interval. A p value of < 0.05 was considered as statistically significant at 95% confidence interval. After 1 year follow up patients in platysma group had significantly better mouth opening (39.84 ± 1.65 mm) compared to both buccal fat pad (36.69 ± 3.41 mm) and nasolabial groups (37.94 ± 0.43 mm). Inter commisural distance was significantly better in patients reconstructed with platysma flap (59.21 ± 0.99 mm) compared to both buccal fat pad (54.11 ± 1 mm) and nasolabial flap (56.84 ± 1.48 mm). Platysma flap lead to significantly better maximal mouth opening compared to both nasolabial and buccal fat pad. Both buccal fat pad and nasolabial lead to comparable mouth opening. Inter commissural distance is maximum with platysma flap followed by nasolabial flap and buccal fat pad. [ABSTRACT FROM AUTHOR]

To assess the efficacy of different flaps along with active physiotherapy for comprehensive management of OSMF. A total of 33 patients of oral submucous fibrosis were admitted and surgically treated. All patients were diagnosed with bilateral oral submucous fibrosis of buccal mucosa. All the patients had advanced oral sub mucous fibrosis with interincisal distance less than 20 mm. Eleven patients were treated with buccal pad of fat, eleven with nasolabial flap and eleven patients were treated with temporo-parietal fascia flap. Physiotherapy was started from the 5th postoperative day and the patients were followed regularly for one year to measure maximum interincisal distance. There was a significant corelation between post-operative mouth opening and regular physiotherapy, exercise and quitting of the habit irrespective of type of reconstruction flap used. On the basis of the result obtained from this study, significant improvement in mouth opening was seen in patients who performed aggressive physiotherapy irrespective of the flap used. Thus we conclude along with the surgical treatment, post-operative physiotherapy and cessation of habit are of equal importance for good prognosis in OSMF patients. [ABSTRACT FROM AUTHOR]

Background: Oral and maxillofacial surgery deals with wide range of oral defects, wound closure, tissue resection, and tissue reconstruction. The purpose of our study is to use amniotic membrane for closure of post surgery defect in patient of oral submucous fibrosis to utilize its growth factor and scaffold nature for effective healing and to evaluate effectiveness of amniotic membrane in treatment outcome. The objectives are to compare post-operative mouth opening, healing of amniotic membrane and buccal fat pad. Material and Method: Diagnosed patients with OSMF are divided into two surgical site Group I (n = 5patients)—Left side buccal mucosa in which resection of fibrous band with coronoidectomy followed by reconstruction of the mucosal defect with BFP. Group II—Right side buccal mucosa in which resection of fibrous band with coronoidectomy followed by reconstruction of the mucosal defect with freeze dried irradiated amniotic membrane. Result: This study suggested that in comparison to buccal fat pad flap, the HAM graft is a better option for oral reconstruction in terms of infection, graft failure, MMO, inflammation, pain. Outcome indicated that the HAM is biologically ideal graft for oral wounds and could be used as clinical alternative for various repair surgery for oral defects. Conclusion: The amniotic membrane was found easy to handle and easy to use with inherent hemostatic property which is observed in all patients. No patients had shown any evidence of any complications. Good pain control observed in patients throughout postoperative period. [ABSTRACT FROM AUTHOR]

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.

The buccal fat pad (BFP) is a specialized encapsulated adipose tissue, located intimately between the buccinator muscle and oral mucous membrane. A small perforation of buccinator muscle can lead to herniation of BFP into the oral cavity, which can be readily mistaken with a pathological entity. In general, the size of herniated BFP is larger than the perforation. The treatment options for BFP are excision or repositioning in its anatomical position if noticed early. This article reports two such cases presenting with herniation of the BFP, following trauma to buccal mucosa and its surgical management. [ABSTRACT FROM AUTHOR]

Buccal fat herniation is a rare traumatic disease that should be included in differential diagnosis of infants' oral cavity mass. History of proceeding trauma, careful evaluation of mucosal perforation aiding the diagnosis. [ABSTRACT FROM AUTHOR]

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.

This study aimed to determine the most effective wavelength for the proliferation of Human Buccal Fat Pad Mesenchymal Stem Cells (BFPMSCs) in cell culture. These cells can be used for different purposes such as regenerative periodontal procedures. Materials and Methods: The wells containing BFPMSCs were subjected to laser irradiation at 635, 660, 808, and 980 nm wavelengths with 1, 1.5, 2.5, and 4 J/cm2 energy densities. Cell proliferation and viability were evaluated after 1, 3, and 5 days with the methyl thiazolyl tetrazolium (MTT) assay. Result: The proliferation rate of human Buccal Fat Pad Mesenchymal Cells (BFPMSCs) was increased on the first and third days at a wavelength of 808 nm and day five at a wavelength of 980 nm in comparison to the control group. Our findings distinguished that PBMT with 635, 660, 808, and 980 nm wavelengths increased the proliferation of BFPMSCs. Conclusion: The best laser radiation setting, which led to the highest proliferation rate of the cells, included a wavelength of 808 nm with 2.5 J/cm2 energy density.

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.

OBJECTIVE: To compare between double layer closure and buccal advancement flap in the management of Oro-antral fistula METHODOLOGY: This Comparative cross sectional study was conducted on 30 patients with oral antral fistula in Maxillofacial Surgery Department, Liaquat University of Medical & Health sciences Hyderabad. The study was conducted from March 2013 to February 2019. Selection of patients was made on inclusion criteria of patient having OAF for more than 15 days, irrespective of location and side. Patients who developed Oro-antral fistula (OAF) because of any pathology or its treatment, and patient having bleeding tendency were excluded. Division of two groups to avoid any bias in this study was done by using random number table. Group-I was treated with buccal advancement flap while group-II with “double layer closure “with buccal fat pad” and 2nd layer with buccal advancement. The outcome was evaluated for any postoperative complications like wound dehiscence, necrosis, infection. RESULTS: Males and females were 67% and 33% respectively. The mean age was 35.03±9.56 years. Maxillary molars were the common site for OAF. Maxillary first molar followed by second molar site was ranked according to frequency of this condition. Buccal advancement procedure was used in group A and in this cluster 86.6% cases were successful. In Group B, a double layered closure procedure was used and the success rate was 93.3% which is statistically not significant. CONCLUSION: Double-layered closure using BFP with buccal advancement flap should be kept as a valuable option in mind in the management of OAF.

Abstract A prolapse of the sinus lining through an extraction socket occurred after 4 weeks. The lining was pushed into the socket and maintained with a buccal fat pad pedicle graft. Healing was complete after several weeks. A sinus decongestant can be prescribed to promote sinus drainage and reduce pressure.

Masseter hypertrophy is an uncommon condition, characterized by an increase in the volume of the masseter region, with the patient presenting functional and aesthetic complaints. Several therapeutic modalities have been suggested for this condition, however, a surgical approach usually presents consistent results in more complex cases. The objective of this article is to report a clinical case of masseter hypertrophy associated with class IV of Kin, treated through partial removal of the masseter muscle, bichectomy and genioplasty. Surgery was performed under general anesthesia in a hospital setting. The planning was previously carried out through prototyped models and radiographs to remove the excess bone shown in the mandibular angle region. Surgical treatment of masseter hypertrophy is effective and long-lasting in severe cases. Additional surgical procedures must be performed in order to provide the best possible result according to the facial deformity found. [ABSTRACT FROM AUTHOR]

Abstract In order to achieve a fixed implant‐supported prosthesis in a posthemimaxilectomy patient, ideal soft and hard tissue rehabilitation is necessary. Here, we present a staged approach for soft tissue reconstruction with local flaps followed by anterior iliac crest bone graft which resulted in a predictable and satisfactory outcome.

Abstract 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.

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Oroantral fistula (OAF) refers to a permanent connection between oral cavity and maxillary sinus. The extraction of maxillary posterior teeth is the most common reason of OAF. Multiple techniques are available to repair this defect. The most used procedures involving local flaps include buccal flap, buccal fat pad (BFP), and palatal rotating flap. We here present an original technique of management of oroantral fistula with displacement of the root into sinus using BFP. [ABSTRACT FROM AUTHOR]

Interpositional gap arthroplasty has established itself as the the standard surgical treatment of Temporomandibular joint (TMJ) ankylosis. The autogenous tissue has replaced the alloplastic and other xenografts materials owing to its bioavailability, easy uptake, and no additional cost. Commonly used autogenous tissue has been temporalis muscle and fascia, fascia lata, skin graft, auricular and costal cartilage, the masseter and/or medial pterygoid muscle. With the turn of the century, TMJ surgeons started using autogenous fat from the lower abdomen and today it has taken over as the most favored autogenous filler material in TMJ ankylosis surgery or total joint replacement (TMJ-TJR). The use of buccal fat pad (BFP) has increased in the last decade due to its local availability and pedicled nature. This paper will discuss various autogenous tissues used in interposition and bring forth the journey of the autogenous fat as the preferred interpositional material now and rest the case in its favor. [ABSTRACT FROM AUTHOR]

Despite the widespread use of pedicled buccal fat pad (BFP) flap in maxillofacial reconstruction, free nonvascular transfer of this fat is not widely used. Dermal fat transfer to the maxillofacial region is a known procedure with good results; however, it needs a skin incision in the donor site. Resorption of this graft is the other problem. Buccal fat with inherent resistance against resorption and ease of harvest is an interesting option. Six cases are reported in this article for the facial soft tissue augmentation in hemifacial microsomia, scar adhesion, temporal hallowing, and the release of TMJ bony ankylosis and check adhesion. [ABSTRACT FROM AUTHOR]

Tumours of salivary glands are rare and have various histo-pathological subtypes. Myoepitheliomas were first classified by Sheldon et al. and the criterion to classify or diagnose it was first defined by Barnes et al. and Sciubba and Brannon. Myoepithelioma accounts for less than 1 % of all salivary gland tumours, 40 % of these tumours occur in the parotid gland while 21 % occur in the minor salivary glands. A case of myoepithelioma of a minor salivary gland of the cheek is described, emphasizing the problems of the differential diagnosis. A 40-year-old female reported to the department with a complaint of a cheek bite on her right side for a few months. The physical examination showed a presence of lobulated whitish mucosa on the right buccal mucosa at the level of the occlusal plane, on palpation it revealed a non-painful mass approximately 1.5 cm in radius, mobile to bimanual palpation. An excisional biopsy was performed under local anaesthesia. Microscopic and immunohistochemistry confirmed the tumour to be a myoepithelioma of a minor salivary gland with the absence of definitive features of malignancy. Due to their infrequency and multiplicity of histopathology, myoepitheliomas present difficulties in diagnosis. Cellular varieties can be misdiagnosed as malignancies. A key to determining diagnostic criteria for myoepitheliomas is to study cellular morphology, cytoplasmic filament expression, and ultrastructural features of the tumour and apply this information to defining myoepitheliomas. Myoepitheliomas are rare tumours, utilization of immunohistochemical staining and electron microscopy are useful tools for the diagnosis of myoepitheliomas to ensure proper treatment and follow-up. • Myoepithelioma of minor salivary gland • Buccal fat pad reconstruction • Electron microscopy and Immunohistochemistry • Benign salivary gland pathology [ABSTRACT FROM AUTHOR]

Background: Gingival recession (GR) is a common clinical feature of periodontal disease and is an undesirable condition. More than 50% of the population has one or more sites with GR ≥ 1 mm. Material and Methods: In this study 15 subjects were subjected to initial periodontal therapy such as ultrasonic scaling and root planning with hand instruments and curettes. Patient is motivated for home care. The buccal fat pad is harvested and sutured in the gingival recession area and followed up for 6 months and root coverage was calculated. Results: At baseline mean recession of 5.60 ± 1.18 mm, probing depth of 0.73 ± 0.59 mm, clinical attachment loss of 6.40 ± 1.18 mm were recorded. At the end of 6 months, the mean recession was reduced from 5.60 ± 1.18 mm to 2.87 ± 0.74 mm, probing depth was increased from 0.73 ± 0.59 mm to 1.73 ± 0.70 mm and clinical attachment loss was decreased from 6.40 ± 1.18 mm to 4.53 ± 0.83 mm.The difference between baseline score and six months score for all three parameters are statistically significant. Conclusion: Buccal fat pad is a predictable procedure to cover Miller's class III and class IV gingival recession defects. There was a definitive improvement in clinical parameters (reduction in gingival recession, increased probing depth, gain in clinical attachment) after 6 months. There was 46.78% improvement in root coverage which was statistically significant.

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.

Background: The oro antral fistula (OAF) is an unnatural epithelialized communication between oral cavity and maxillary sinus. It may heal spontaneously but a larger fistula requires surgical intervention. OAF causes excruciating pain, escape of fluids from nose, escape of air from mouth into nose, epistaxis, change in voice due to resonance, purulent discharge in case of chronic OAF, post nasal discharge, popping out of antral polyp into oral cavity and sinusitis. Closure of OAF is strenuous, technique sensitive and challenging. Aims and Objectives: To compare and evaluate the efficacy of buccal fat pad and buccal advancement pad for closure of oroantral fistula. Materials and Methods: Twenty patients of age ranging from 24–64 years with complaint of OAF were included in this prospective, comparative analytic study. In group I, OAF was treated with a buccal advancement flap and in group II, BFP was sutured over the defect. All patients were called for follow up on 1st, 7th, 14th and 21st day post operatively. Pain, mouth opening, edema, infection and wound dehiscence were evaluated on each visit. Result: The mean age of selected patients in both the treatment groups was comparable. The mean age of patients in group I was 45.00 ± 13.33 years whereas in group II the mean age was 44.00 ± 13.13 years. Pain, edema was less in Group I. Mouth opening was less in group II. We did not encountered infection and wound dehiscence in any case. Conclusion: Various techniques can be utilized for the closure; regardless of the technique used, success of the surgical procedure depends on effective removal of fistulous tract and complete extermination of any sinus pathology and/or infection. The major factors determining the type of surgery for closure of OAF are dimension and location of the defect. The other decisive factors could be the adequacy and health of adjoining tissue. We observed buccal fat pad to be better option for closure of OAF, despite of its more morbidity; as all the complications were of some time period and when evaluated for long term. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Intraoral squamous papilloma is an uncommon lesion which presents as a verrucous, exophytic or papillary growth of the oral mucosa. Human Papilloma Virus (HPV) is often detected associated with this condition but HPV may be an incidental finding. In this report we present the surgical management of squamous papilloma of hard palate and discuss its association with HPV.

Lipomas are benign tumors of adipose tissue. They represent the most common mesenchymal neoplasm but are relatively rare in the oral and maxillofacial regions. The purpose of this study is to present an unusual case of a large lipoma of the buccal space and its excision by an intraoral approach. A 38-year-old male patient presented with an otherwise asymptomatic swelling of the right cheek that had first been noticed four years earlier and had subsequently exhibited gradual, continuous enlargement with stable dimensions over the last year. The patient was obese but otherwise healthy. Examination revealed a movable, well-circumscribed, non-fluctuant, soft-elastic large swelling of the right buccal and parotid-masseteric region with normal overlying skin and no bruit. Ultrasound and MRI findings, as well as fine needle aspiration, were suggestive of lipoma. The lesion was excised under general anesthesia through an intraoral approach. The tumor measured 7.0 cm × 5.3 cm × 1.6 cm and was separated from the surrounding tissues by a thin capsule. Histopathologic examination rendered a final diagnosis of lipoma. No signs of recurrence were noted. Although lipomas are the most common mesenchymal neoplasm, they do not usually occur in the oral and maxillofacial region, especially as large lesions are located in the buccal space, and may pose diagnostic and therapeutic challenges., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Katoumas et al.)

Introduction: The patients with early stage, clinically node-negative oral squamous cell carcinomas are usually treated with oral surgical excision of primary tumor. Marginal mandibulectomy of posterior mandible is difficult with an adequate safety margin via an intraoral. The cheek-splitting incision allows marginal resection at the posterior mandible under direct vision and it can avoid invasion to the neck region. The Buccal fat pad flap (BFP) grafting is considered feasible for the reconstruction of surgically induced defects, because of it has a high success rate due to BFP's rich vascularity, proximity to the recipient site, low donor-site morbidity, and simple surgical procedure for grafting. The combination of BFP and The mucosal defect covered with fibrin glue and polyglycolic acid sheet (MCFP technique) can makes early intake after surgery, excellent wound-healing and pain-relieving effects. Case report: We reported a case of squamous cell carcinoma arising at the posterior mandibular gingiva that was treated by marginal mandibulectomy via a cheek-splitting transbuccal approach, reconstructed the defect after surgery using a BFP covered with MCFP technique. Conclusion: A major advantage of this approach is that it obtains an adequate margin of the posterior site without requiring a cervical incision thus allowing early intake after surgery and excellent wound-healing and pain-relieving effects.

Juvenile Aggressive Ossifying Fibroma (JAOF) is a benign but locally aggressive fibro-osseous lesion. It is a rapidly growing non-odontogenic neoplasm of the jaws that is often confused with malignant conditions because of its aggressive clinical behaviour. We report a case of maxillary JAOF in a 6-month old child which necessitated partial maxillectomy. The resultant defect was reconstructed with pedicled buccal fat pad. The patient has been followed up for a period of 5 years, with no sign of recurrence.

Background and Aim: Several surgical techniques have been so far used for treating Cerebrospinal Fluid (CSF) leakage (rhinorrhea) such as using abdominal fat or fascia lata, but these methods have complications such as the presence of several surgeons in variable fields in the operating room or cosmetic complications for donors such as the surgical scar. This study aimed to investigate using buccal fat pad for management of traumatic CSF leakage. Methods and Materials/Patients: In this clinical trial, 46 patients with traumatic CSF leakage were enrolled according to inclusion criteria and randomly divided into intervention and control groups. Buccal fat pad for the intervention and abdominal fat for the control were inserted in the defect of the anterior cranial cavity by applying endoscopic sinus surgery. The patients were followed up for 1 year postoperatively. Results: All patients were improved with no recorded report of CSF leakage relapse. In the intervention group, temporary complications such as edema (18.2%), numbness (9.1%) and facial asymmetry (9.1%) were observed in resected buccal fat pad areas. Also the control group all developed abdominal scar. The duration of surgery in the intervention group was significantly shorter than control (P=0.02). Conclusion: Using buccal fat pad for management of CSF leakage is a highly effective and reliable method which requires simple procedure with low cosmetic complication and short duration of surgery compared with other methods such as an abdominal fat graft. In addition, using buccal fat pad has better cosmetic results, so we suggest this surgical method for patients with CSF leakage

Statement of the Problem: One major goal of tissue engineering and regenerative medicine is to find an appropriate source of mesenchymal stem cells (MSCs) with higher differentiation ability. Purpose: In this experimental study, the osteogenic and chondrogenic differentiation ability of buccal fat pad derived MSCs (BFP-MSCs) with gingival derived cells (GDCs) were compared. Materials and Method: BFP-MSCs and GDCs were cultured enzymatically and expanded. The expanded cells were analyzed for membrane-associated markers, using flow cytometry. Then the ability of these cells to differentiate into osteocyte and chondrocyte was assessed morphologically and by mRNA expression of collagen I (COLL), BGLA and bone morphogenetic protein 2 (BMP2) using qRT-PCR. Results: Flow cytometry analysis showed that both BFP-MSCs and GDCs expressed the characteristic stem cell markers such as CD73, CD44, and CD90, whereas they did not express hematopoietic markers. Mineralized calcium deposition was observed apparently in BFP-MSCs cultured in osteogenic medium but GDCs showed fewer mineralized nodules. The mRNA expression levels of BGLA and BMP2 showed 7×105 and 733-fold more mRNA expression in BFP-MSCs treated with differentiation media compared to the control group. In chondrogenic differentiation, BFP-MSCs transformed from a spindle to a cuboidal shape while GDCs showed only a slight transformation. In addition, mRNA expression of COLL showed 282-fold higher expression in BFP-MSCs in comparison to the control group. Such significant difference in mRNA expression of BGLA, BMP2, and COLL was not observed in GDCs compared to their corresponding controls. Conclusion: Based on the present results, BFP yields a greater proportion of stem cells compared to gingiva. Therefore, this tissue can be introduced as an easily available source for the treatment of periodontal defects and other maxillofacial injuries.

Abstract Background Squamous cell carcinoma (SCC) is the most commonly occurring malignant tumor in the oral cavity. In South Korea, it occurs most frequently in the mandible, tongue, maxilla, buccal mucosa, other areas of the oral cavity, and lips. Radial forearm free flap (RFFF) is the most widely used reconstruction method for the buccal mucosal defect. The scar of the forearm donor, however, is highly visible and unsightly, and a secondary surgical site is needed when such technique is applied. For these reasons, buccal fat pad (BFP) flap has been commonly used for closing post-surgical excision sites since the recent decades because of its reliability, ease of harvest, and low complication rate. Case presentation In the case reported herein, BFP flap was used to reconstruct a cheek mucosal defect after excision. The defect was completely covered by the BFP flap, without any complications. Conclusion Discussed herein is the usefulness of BFP flap for the repair of the cheek mucosal defect. Also, further studies are needed to determine the possibility of using BFP flap when the defect is deep, and the maximum volume that can be harvested considering the changes in volume with age.

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.

Purpose: The aim of this retrospective study was to describe the efficacy of management of bisphosphonate-related maxillary osteonecrosis, which had resulted in an oroantral fistula formation, by performing sequestrectomy, platelet-rich fibrin (PRF) and buccal fat pad (BFP) flap. Patient and Methods: A total of 7 patients diagnosed with stage III maxillary medication-related osteonecrosis according to guidelines of the American Association of Oral and Maxillofacial Surgeons. All patients complained of persistent pain, swelling and purulent drainage with sinusitis. In order to keep the infection under control, the patients first received an antibiotic combination for 2 weeks. Then, sequestrectomy and bone debridement were performed under general anesthesia. After that, an antrectomy was performed via endoscopic sinus surgery in some cases. And the fistula was closed with BFP after or before the PRF application to the region depending on the size of the fistula. Results: The fistula was successfully closed. After a mean follow-up of 16 months, no symptoms were seen in the patients. Conclusions: The patients were successfully managed with a combined treatment consisted of sequestrectomy, PRF and BFP. We suggest that large defects arose from medication-related osteonecrosis of the jaw can be managed with such a combined approach in order to lessen the recurrence risk. [ABSTRACT FROM AUTHOR]

A prolapse of the sinus lining through an extraction socket occurred after 4 weeks. The lining was pushed into the socket and maintained with a buccal fat pad pedicle graft. Healing was complete after several weeks. A sinus decongestant can be prescribed to promote sinus drainage and reduce pressure. [ABSTRACT FROM AUTHOR]

OBJECTIVE: To compare between double layer closure and buccal advancement flap in the management of Oro-antral fistula METHODOLOGY: This Comparative cross sectional study was conducted on 30 patients with oral antral fistula in Maxillofacial Surgery Department, Liaquat University of Medical & Health sciences Hyderabad. The study was conducted from March 2013 to February 2019. Selection of patients was made on inclusion criteria of patient having OAF for more than 15 days, irrespective of location and side. Patients who developed Oro-antral fistula (OAF) because of any pathology or its treatment, and patient having bleeding tendency were excluded. Division of two groups to avoid any bias in this study was done by using random number table. Group-I was treated with buccal advancement flap while group-ll with "double layer closure "with buccal fat pad" and 2nd layer with buccal advancement. The outcome was evaluated for any postoperative complications like wound dehiscence, necrosis, infection. RESULTS: Males and females were 67% and 33% respectively. The mean age was 35.03±9.56 years. Maxillary molars were the common site for OAF. Maxillary first molar followed by second molar site was ranked according to frequency of this condition. Buccal advancement procedure was used in group A and in this cluster 86.6% cases were successful. In Group B, a double layered closure procedure was used and the success rate was 93.3% which is statistically not significant. CONCLUSION: Double-layered closure using BFP with buccal advancement flap should be kept as a valuable option in mind in the management of OAF. [ABSTRACT FROM AUTHOR]

In order to achieve a fixed implant‐supported prosthesis in a posthemimaxilectomy patient, ideal soft and hard tissue rehabilitation is necessary. Here, we present a staged approach for soft tissue reconstruction with local flaps followed by anterior iliac crest bone graft which resulted in a predictable and satisfactory outcome. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]