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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]

Background: The integration of neck liposuction with FaceTite Manipulus Radiofrequency (RF) technology and buccal fat pad excision for enhanced neck rejuvenation promise heightened precision and efficacy in sculpting the neck and jawline. Neck liposuction, coupled with RF technology, provides controlled thermal energy for adipose tissue treatment and collagen remodeling, while buccal fat pad excision offers refined contouring of the lower face and neck. This integrated approach aims to optimize patient outcomes and advance the field of esthetic plastic surgery. Methods: A prospective study was conducted from 2016 to 2023 on 80 consecutive patients who presented to the author's private clinic and required neck remodeling surgery for esthetic purposes. Patients were monitored and clinic appointments were scheduled at intervals of 0, 1, 3, 6 and 12 months post-treatment for evaluation. A tape measure recorded submental length at 1 and 6 months, and a satisfaction survey was administered one week before surgery and after six months. Physicians assessed improvement using a five-point scale for patient satisfaction and a four-point scale for overall improvement. Results: All patients underwent successful RFAL treatment, consistently achieving satisfaction with the outcomes. The average reduction in submental length measured 23 mm during the 6-month follow-up period. Additionally, the removal of buccal fat pads played a pivotal role in facial slimming and enhancing the esthetics of the upper cheek region. Conclusions: The integration of neck liposuction with FaceTite RF technology and buccal fat pad excision offers a promising approach for enhanced neck rejuvenation and facial contouring. This combined method demonstrates heightened precision and efficacy in sculpting the neck and jawline, aiming to optimize patient outcomes and advance the field of esthetic plastic surgery. Level of Evidence IV: 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. [ABSTRACT FROM AUTHOR]

The aim of this study was to compare the effectiveness of the Gaussian and Flat‐Top profiles in proliferation and differentiation of mesenchymal stem cell of buccal fat pad. Based on the timing schedule and type of laser handpieces, the cells were assigned to a control group with no radiation, and two irradiation test groups (980 nm) with Flat‐Top (F) (power of 1.1 W, beam area of 1 cm2) and standard Gaussian (G) (power of 0.7 W, beam area of 0.5 cm2) handpieces. Each test group was divided into three subgroups, receiving one time (60 J/cm2), two times (120 J/cm2), and three times (180 J/cm2) irradiation. 3‐(4,5‐dimethylthiazol‐2‐yl)‐2, 5‐diphenyltetrazolium bromide (MTT) and Annexin V tests were performed. The Alizarin Red staining and polymerase chain reaction tests were done both at the beginning and the end of the first and second weeks. The degree of mineralization and expression of osteogenic markers, RUNX2, OCN, and OPN were evaluated. Based on the MTT and Annexin V test results, both test groups outperformed the control group in degrees of cell proliferation during the first day of laser irradiation (p < 0.05). After one and two times irradiation, the expression of osteogenic markers in the test groups was significantly higher than the control group. PBM with Flat‐Top and Gaussian handpieces can enhance ossification and cell differentiation regardless of the type of handpieces. [ABSTRACT FROM AUTHOR]

PurposeMethodsResultsConclusionsThe aim of this retrospective case review is to present a novel surgical technique used in the treatment of recalcitrant lower eyelid retraction.This study was performed as a retrospective case review of 4 patients who have failed standard conservative surgical interventions for lower eyelid retraction repair. 3 patients developed lower eyelid retraction following surgical intervention for orbital trauma and 1 patient developed lower eyelid retraction in the setting of granulomatosis with polyangiitis. The surgical technique was identical in each patient and performed by an oculofacial plastic surgeon, sometimes together with an oral and maxillofacial surgeon. Follow-up results for all patients were assessed at 1 week, 1 month, and 3 months.All four patients demonstrated initial improvement in lower eyelid position, fullness, and height. A common finding was mild lateral postoperative entropion, which was easily overcome with an upper eyelid tarsoconjunctival flap. There were no surgical complications sustained in any of the cases.This retrospective case review provides a novel surgical option for the correction of recalcitrant lower eyelid retraction. The excellent vascularity provided by this flap, location, and easy access support its use. A prospective study comparing alternative solutions would be useful in comparing the buccal fat pad vascularized pedicle to alternative methods used to correct refractory and cicatricial lower eyelid retraction. [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]

Objective: To review the available evidence on the use of the Buccal Fat Pad in primary and secondary Cleft Palate repair. Methods: This is a narrative review. A computerized literature search was conducted for articles published till February 2022 using the Mesh phrases buccal fat pad AND cleft palate, Bichat's Fat pad AND cleft palate, buccal fat pad OR Bichats Fat pad AND cleft palate. Results: A total of 35 articles were included in this review based on the set eligibility criteria. Most of the studies were retrospective case reviews (n = 16, 45.7%), and the aggregate number of patients from all included studies was 666. Reported uses of the buccal fat pad (BFP) in association with cleft palate repair include the closure of central cleft palate defect and nasal floor in primary cleft palate repair, oronasal fistula repair following primary repair of cleft palate, and closure of relieving incision defect in primary repair of cleft palate. Complications reported were 24 cases of Oronasal Fistula (ONF), 2 dehiscences, and 4 transient mucosal defects. Conclusion: The high success rate, vascularity, ease of tissue harvest, and low donor site morbidity all support its use as an adjunct flap in cleft palate repair, especially in the closure of wide palatal clefts, to prevent post-palatal repair fistula, wound contracture, and subsequently velopharyngeal insufficiency and possibly midface hypoplasia. [ABSTRACT FROM AUTHOR]

Oroantral Communication (OAC) is an unnatural communication between the oral cavity and maxillary sinus commonly seen to occur after the extraction of maxillary premolars and molars and when it fails to close spontaneously. Once the communication undergoes epithelialization, it leads to the formation of an oroantral fistula. We present a case of oroantral communication in a 36-year-old female patient who presented with an oroantral communication and was successfully treated with an auricular cartilage graft along with a review of various treatment modalities used to manage oroantral communication. Soft-tissue local advancement flaps, buccal pad fat, tongue flaps, and other treatment options have been tried in the past with a variable degree of success. We used auricular cartilage with buccal pad fat to obtain a three-layer closure and achieved a successful result. [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]

Background: During reduction malarplasty, cheek bulging could be found immediately after zygomatic complex is moved inwards, backwards and upwards. As patient is in the supine position during surgery, the effect of gravity is eliminated, so the only reason for the bulge is the redistribution of the soft tissue in the deep facial spaces. The buccal fat pad, with its main body behind the zygomatic arch and buccal extension in the cheek area, is most likely to be responsible for the bulge. Methods: 3D buccal extension models were reconstructed from preoperative and long-term follow-up CT images and the volume measured. By comparing the pre- and postoperative 3D models, the shape deviation of the buccal extension and facial soft tissue can be identified. Results: Eleven patients (22 buccal extensions) met the inclusion criteria. Compared with the preoperative buccal extension volume, the postoperative volume increased significantly. By comparing the reconstructed models, the buccal extension volume increase with anteroinferior protrusion can be visually detected, and cheek bulging was clearly identified on the lower face. The bulging area coincided with the projection of the buccal extension on the skin surface. Conclusions: Reduction malarplasty may cause volume redistribution of the buccal fat pad. Therefore, preoperative assessment of the size of the buccal fat pad based on CT images is recommended. The buccal extension volume increase with anteroinferior protrusion is an important cause of postoperative cheek bulging and should be considered during treatment. Level of Evidence IV: 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. [ABSTRACT FROM AUTHOR]

Purpose: To describe the benefits of covering the extrasinusal length of extramaxillary zygomatic implants with a pedicled buccal fat pad flap through a tunnel approach. Materials and Methods: Four extramaxillary zygomatic implants were placed in 10 patients and loaded immediately with an acrylic provisional fixed prosthesis. The extrasinusal length of every implant was covered with a pedicled buccal fat pad flap. Study variables were implant survival rate, peri-implant soft tissue recession (PISTR), peri-implant soft tissue condition (PISTC), modified Bleeding Index (mBI), and suppuration. The statistical analysis comprised the Brunner-Langer model of longitudinal data for each variable and the analysis of variance to assess main effects and interactions. Results: All the zygomatic implants showed osseointegration, resulting in a survival rate of 100%. The PISTR was evaluated after surgery (T0) and after 12 months (T1), statistically significant differences being observed (P = .014). Recession also depended on specific implant positioning; zygomatic implants in the anterior were found to have a higher risk of recession vs implants in the posterior (P = .065). The PISTC was assessed at T0 and T1, and no statistically significant changes were observed (P = .718). Bleeding on probing was present in 10% of the implants at T0 and in 15% at T1, the difference being nonsignificant (P = .317). Conclusion: The use of a pedicled buccal fat pad flap to cover the extrasinusal length of extramaxillary zygomatic implants appears to reduce the risk of soft tissue recession and exposure of the implant surface to the oral cavity. [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.

To understand how thyroid eye disease (TED) impacts buccal fat pad (BFP) volume. In this cohort study, computed tomography (CT) scans and charts of adult patients with and without TED were obtained from an institutional database. The primary outcome was BFP volume in cubic centimeters. Three independent, blinded observers analyzed scans using Horos, a free, open-source medical image viewing software. Bivariate and multivariable analyses were performed. We determined sample size using an effect size based on published reports of the minimum amount of fat excision needed to notice a clinical difference. Equivalence testing against upper and lower bounds set by the same effect size was conducted to assess practical significance of the results. Our sample was sufficient to detect a difference as large as 1.5cc with 95% power. 72 scans were included in our study, 24 TED patients and 48 controls. Mean BFP volume was not statistically different between TED patients and controls (3.96 cc vs 4.06 cc, p =.778). Analysis of covariance adjusting for relevant patient factors (age, sex, and BMI) also failed to find a significant difference between groups. Equivalence testing was significant (p <.001) and revealed the observed difference between groups was less than any clinically meaningful difference. For an effect size of 1.5cc, the data suggests there is a 5% risk of a false negative. TED was not associated with a significant difference in BFP volume, suggesting that the BFP is spared from TED-related soft-tissue expansion. [ABSTRACT FROM AUTHOR]

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]

Oroantral Fistula Closure Using Double-Layered Flap: Greater Palatine Artery Flap and Buccal Fat Pad Buccal fat pad, combined approach, double-layered flap, greater palatine artery pedicled flap, nasal flap, oroantral fistula Keywords: buccal fat pad; combined approach; double-layered flap; greater palatine artery pedicled flap; nasal flap; oroantral fistula EN buccal fat pad combined approach double-layered flap greater palatine artery pedicled flap nasal flap oroantral fistula 1824 1827 4 07/14/23 20230801 NES 230801 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. [Extracted from the article]

Objectives: To investigate the effect of buccal fat pad transplantation in front of the aponeurosis to correct Asian upper eyelid depression. Methods: Eighty-five individuals who were treated with buccal fat pad transplantation were recruited for this study. The upper eyelid depression data were collected before and after treatment, and the aesthetic outcomes were assessed using the Global Aesthetic Improvement Scale (GAIS) and the Likert scale. Results: All patients obtained natural-looking eyelids, and the sunken contour deformity improved. The mean preoperative sunken depth was 6.7±1.0 mm (4–12 mm), and the mean sunken depth at the last follow-up was 4.2±0.9 mm (2–6 mm) (P <0.05). The visual analogue scale score was 2.12±1.75 (1–4) in the immediate postoperative period. The GAIS scores were satisfactory (very much improved, 89.4%; much improved, 7.1%; and improved, 3.5%). According to the Likert scale scores, all patients were satisfied with the clinical outcomes (excellent, 87.1%; very good, 9.4%; and good, 3.5%). A 'fair' or 'poor' result was not reported by any patient. Conclusion: Buccal fat pad transplantation corrects upper eyelid depression in a simple, safe, and effective manner and can efficiently fill the depressed portion and restore a beautiful double eyelid. 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. [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]

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Purpose: Buccal fat pad (BFP) is used for the closure of large oroantral defects caused by surgical removal of the necrotic bone in patients with medication-related osteonecrosis of the jaw (MRONJ). This study aimed to evaluate the use of BFP for the closure of maxillary sinus defects in stage 3 MRONJ patients. Methods: This study recruited 61patients with large oroantral defects caused by MRONJ, including 49 patients with cancer and 12 patients with osteoporosis. Lesions were evaluated clinically and radiographically. Results: Among the 61 patients, 51 (83.6%) healed uneventfully, and 5 patients (8.2%) had local dehiscence and exposed bone; these 56 patients (91.8%) all healed after first or second operation. The Eastern Cooperative Oncology Group Performance Status was associated with being non-cured and might be an indicator for the healing process. All patients experienced a significant increase in body weight postoperatively. Conclusions: This study suggest that block resection with removal of the necrotic bone combined with radical sinusotomy and closure of the defect with BFP is a reliable method to cure MRONJ lesions with a high success rate, and successful operation and prosthetic rehabilitation may improve body weight and the quality of life. The study was approved by the appropriate ethical approval for the Copenhagen ONJ Cohort (protocol no. H-6–2013-010) November 20, 2013. [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]

The purpose of this study was to examine the biological properties of the buccal fat pad (BFP)-derived tissue stromal vascular fraction (tSVF) in vitro and compare them with BFP-derived cellular SVF (cSVF). Furthermore, a clinical pilot study assessed the safety of using BFP-derived tSVF for maxillofacial bone regeneration. This study was performed in two sections: 1) experimental section: BFP tissue was harvested from three healthy donors, and then cSVF and tSVF were isolated by enzymatic and mechanical methods to assess their biological properties and 2) clinical section: Ten patients with maxillofacial bone defects were enrolled according to eligibility criteria and offered two options for surgery, including autologous BFP-tSVF (n = 5) and autologous bone grafting (n = 5), to evaluate safety after a year of follow-up. The BFP-tSVF exhibited high cell viability and various cell surface markers, including CD45, CD31, and CD34. There was no population-doubling time and multilineage differentiation capacity compared with BFP-cSVF. BFP-tSVF is safe because of the lack of intervention-related adverse events reported in donor and surgery sites during a one-year period. In addition, cell therapy was feasible because it can be performed during surgery and requires little preparation time. Patients in the ABG group experienced pain and tenderness in the iliac crest, leading to dissatisfaction and complications. The experimental results confirmed that the cells isolated from BFP-tSVF have stemness properties similar to BFP-cSVF. Clinical evaluation also indicated that this cellular product could be used safely to regenerate maxillofacial bone defects. [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.

Purpose: The selection of candidates for buccal fat pad (BFP) removal depends on the patient's requirements, the subjective surgeons' evaluation, and objective clinical factors. This cross-sectional observational study aimed to identify objective clinical and ultrasonographic parameters as indicators of cheek contouring with BFP excision. Methods: Sixty-six patients with cheek fullness complaints were examined by two experienced surgeons to determine if they were good candidates for the procedure. Thereafter, participants underwent clinical and ultrasonographic assessments in a separate session to aid in the surgical decision-making. The association between the clinical judgment for BFP excision and the study variables was analyzed individually and adjusted for confounders using binary logistic regression and grouping analyses. Results: Forty-nine participants were regarded as suitable and 17 as non-suitable for the procedure. After regression analysis, cheek skin-fold thickness > 6.00 mm, midfacial contour > 2.20 mm, ovoid/triangular facial form, and ultrasonographic BFP volume > 2.05 mL remained as robust individual indicators for the suitability for the procedure. However, the grouping analysis showed that patients having three-to-four significant criteria synchronously had significantly higher odds for eligibility with excellent discrimination capability. Conclusion: Although high values of cheek skin-fold thickness, midfacial contour, and ultrasonographic BFP volume, as well as an ovoid/triangular facial form, might be robust indicators for the suitability for BFP excision, the surgical decision-making should not be based on isolated parameters. Instead, those patients possessing a combination of at least three of these specific eligibility criteria above the threshold value might be considered the best candidates for the procedure. [ABSTRACT FROM AUTHOR]

Oro-antral fistula is one of the possible per and post operative complications encountered during avulsion of antral teeth, particularly maxillary second premolars and first molars. We report the case of a 38-year-old immunocompromised patient in whom ulcerative periodontitis caused the avulsion of several maxillary teeth with a subsequent oro-antral communication associated with a chronic maxillary sinusitis. A pedicled buccal fat pad flap was used to close this fistula. The result obtained was compared with the current data in the literature. [ABSTRACT FROM AUTHOR]

Oroantral fistulae (OAF) are surgical sequelae that require complete resection and often leave large defects for the surgeon to repair. Closing these lesions is often technique sensitive and requires a detailed protocol, which, if not adhered to, can lead to recurrence. This case report presents a combined approach to closing an OAF by first excising the fistula and then resecting to retrieve the buccal fat pad to form a pedicle graft over the wound site. Next, a platelet-rich fibrin membrane is sandwiched over the buccal fat pad and completely covered by a buccal advancement flap. This triple-layered technique is a novel method to close a chronic OAF. [ABSTRACT FROM AUTHOR]

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]

Background  Fascia lata and tendon grafts are frequently utilized to support the paralyzed midface and to extend muscular reach in McLaughin style, orthodromic temporalis transfers. The grafts are frequently placed in a deep subcutaneous positioning that can lead to the development of a, bowstring deformity in the cheek. This paper describes insertion of tendon grafts into the midfacial corridor collectively formed by the buccal, submasseteric and superficial temporal spaces. Methods  Over a seven-year period, all patients that underwent insertion of facia lata and tendon grafts in the midfacial corridor were included. Demographic information, perioperative variables and clinical outcomes were collected and analyzed. Results  A total of 22 patients were included with a mean age of 64.3 years (33–86). There were multiple etiologies for the facial weakness including acoustic neuroma (9.1%), Bell's palsy (13.6%), facial nerve schwannoma (9.1%), temporal bone fracture (4.6%) and malignancy (22.7%). Midfacial corridor grafts were utilized in combination with nerve transfers (V-VII and XII-VII) in nine patients, McLaughin style temporalis transfers in 12 and as a standalone procedure in one individual. During the study period, no patients exhibited a tethering, or concave deformity in the midface. Additionally, no impingement, difficulties with mastication, parotitis or hematoma were encountered. One patient developed a postoperative infection, that was successfully managed. Conclusion  Placement of tendon or fascia grafts for static support or tunneling of an orthodromic temporalis transfer through the midfacial corridor can be performed rapidly while providing midfacial support and avoiding the creation of visible cutaneous deformities. [ABSTRACT FROM AUTHOR]

Verrucous hyperplasia (VH) is a rare and potentially malignant exophytic oral mucosal lesion with a verrucous or papillary surface. VH has a tendency to transform into its malignant counterpart, verrucous carcinoma, which is clinically indistinguishable, yet histologically variable. The most common site of predilection is the buccal mucosa and VH more prevalent in patients with habits of areca nut chewing or smoking. A biopsy of the lesion with the surrounding normal mucosa and adequate depth should be performed to histopathologically to diagnose the condition and provide treatment management accordingly. The present study describes the case of a 37-year-old male with VH of the buccal mucosa that was successfully managed by surgical excision and reconstruction using the buccal fat pad (BFP). BFP was used due to its higher vascularity, its proximity to the donor site and to provide less scar contracture. The patient was followed up regularly and the surgical site was health with uneventful healing and complete mucolisation. [ABSTRACT FROM AUTHOR]

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. [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.