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SummaryComparison of the lipid content of the buccal and abdominal subcutaneous fat depots by gas liquid and thin-layer chro-matography during gestation and infancy reveals no qualitative difference in major lipid classes, and small unexplained differences in triglyceride fatty acid composition. Similar alterations in composition occur in both tissues during the third trimester of pregnancy. The metabolic response of adipose tissue in these two sites to in utero and dietary influences of infancy is probably identical. Compositional differences do not appear to explain the preservation of the buccal pad in starvation states.

Intra oral reconstruction with buccal fat pad (BFP) is an identical procedure during reconstructive head and neck surgery. It has a successful outcome in restoring both soft and hard tissues for more than 3 decades. The purpose of this study was to represent a series of cases and review of the recent diversified application of BFP in intra-oral region during reconstruction. The Authors are presenting 12 cases (Male – 8/66.7%; Female – 4/33.33%, mean age – 66.33 years) of BFP reconstruction from small to medium sized defect in oral cavity. The diameter of the BFP graft was between 10 mm and 55 mm. Only one case was restored in mandible while others were in maxillary region. All patients were recovered within a short time. The yellow fat tissues were turned into reddish color within 1 week. Patient recovered with almost normal mucosa before 4th week. BFP reconstruction had considered as a quick and easy to restore flap during most intra-oral reconstruction. Rapid healing without any complications added additional advantage. High blood supply and easy access make it as a first consideration. We also evaluated the merits, demerits, distance between host and donor site, size of defect and site of reconstruction.

The masticatory fat pad is a structure frequently encountered during intraoral surgical approaches to the mandibular ramus. An unusual case of herniation of the fat pad secondary to minor trauma is presented.

During the fall meeting of the American Academy of Facial Plastic and Reconstructive Surgery, Washington, DC, William J. Wolfenden, Jr, San Francisco, presented a technique of jowl sculpting by buccal fat removal and rhytidectomy. According to Wolfenden, 20% of patients undergoing rhytidectomy could benefit from reduction of the cheek rounding accomplished by this procedure. He has used this technique since 1987 in 20% of rhytidectomies performed, and, in an occasional patient, as the only procedure. The technique is strictly intraoral through a 1-mm incision just inferior and posterior to the parotid duct orifice. The buccal fat pad is uncovered with a blunt-tip suction cannula or scissors. A suction-assisted lipectomy is then performed removing half to two thirds of the fat pad. The mucosal incision is closed with an absorbable suture. Perioperative cephalosporin is used to prevent infection. Wolfenden cautions that outcome cannot be appreciated before one year, at which time

Since the term traumatic pseudolipoma of the buccal mucosa was originally propounded to describe a traumatic herniation of the buccal fat pad, five additional cases have been reported. The evidence from these cases, together with the occurrence of similar lesions of the buttocks and anterior abdominal wall, is presented, and the suggestion is made that there is now sufficient reason to believe that this condition is a clinical entity for which the name traumatic pseudolipoma would appear to be justified.

Two cases presenting bad sequelae of scar tissue formation are reported. The use of a fat graft, with the buccal pad of fat as a donor site, is described, and the advantages of this procedure for intraoral surgical procedures are emphasized.

I n 1961 Kamiyama’ reported reciprocal activity of the superior (SLP) and inferior (ILP) bellies of the lateral pterygoid muscle in 12 human subjects. He found that the SLP was active during closing, retraction, and lateral movement in the ipsilateral direction while the ILP was active during opening, protrusion, and lateral movement in the contralateral direction. McNamara2 demonstrated in monkeys that the ILP acts synergistically with the suprahyoid muscles in mouth opening while the SLP is active during mouth closing. Lipke et a1.3 reported in 1977 that electromyographic (EMG) studies in 10 human subjects revealed independent activity of the two bellies of the lateral pterygoid muscle. However, recent reports by Lehr and Owens4 and Auf der Mau? have claimed that separate roles for the ILP and SLP in humans could not be supported electromyographically. Miller and Vargervik” and Mahan et al.’ reported three different EMG patterns from the right lateral pterygoid muscle. The objective of the present study was to record simultaneous EMG activity in the right SLP and ILP and to determine the response of each belly of the muscle during clenching of the teeth and at basic mandibular positions. Fig. 1. Parasagittal section through left TMJ bisecting superior belly of lateral pterygoid muscle. A = Mandibular condyle; B = articular eminence; C = inferior belly of lateral pterygoid muscle (ILP); D = superior belly of lateral pterygoid muscle (SLP); E = fascia and fat lateral to ILP; F = temporal muscle fibers; G = buccal fat pad; and H = maxillary antrum.

The use of a pedicled buccal fat pad graft to line the cheek defect after excision of a large oral leukoplakia is described. The advantages of this fat graft over a split-thickness skin graft are discussed.

The use of unlined buccal fat pad as a pedicled graft to close palatal defects is reported. The advantages of this procedure are described.

805 normal-for-age human embryos and fetuses were used to study early prenatal fat development. The investigation included observations on stages of fat morphogenesis at the light microscopic level and computerized image analyses of fat lobule size and number. The buccal fat pad was selected as a model system for the analyses. Fat tissue differentiates between the 14th and the 16th weeks: there are five morphogenic phases in adipose tissue formation, strongly associated with the formation of blood vessels. Fat lobules are the earliest structures to be identified before typical vacuolated fat cells appear. Concerning fat lobule size and number, we show that after the 23rd week the total number of fat lobules remains approximately constant, while from the 23rd to 29th week the growth of adipose tissue is determined mainly by an increase in size of the lobules. These results suggest that the 14th through the 23rd week is a sensitive period in fat lobule development, and that disturbances of normal adipogenesis during this period may play a role in the etiology of obesity in later life.

A case is described of an injury involving herniation of the buccal fat pad. A differential diagnosis is outlined, and the results of the patient’s management are discussed.

A combined procedure removing the buccal fat pad by excision and the subcutaneous fat of the cheek and neck by lipoplasty is described; this results in an improved contour in both the cheeks and neck. The technique has been applied in 28 patients of various ages without complications and with satisfactory results. Both the immediate results of the operation and the results noted 1 year or more after the operation are very satisfactory. Excellent results have been noted for nine young patients, and good results were obtained in 19 older patients. A review is given of the findings previously reported in the literature. At present, we are inclined to believe that removal of the buccal fat pad and lipoplasty of the subcutaneous fat of the cheeks and neck offers more improvement than either procedure alone. It is hoped that this combined procedure will give a solution to the troublesome problem of chubby cheeks and lead to a method of safely recontouring the cheek to a more youthful and beautiful appearance.

There is increasing concern for a better clinical understanding of the early emergence and recognition of patterns of fat formation (Committee on Nutrition, 1981. Despite an increasing number of clinical publications on fatness in children, there is no definitive description of the prenatal morphogenesis of human subcutaneous fat. Quantitative data on size and number of fat cells during gestation are also very limited.

• The buccal fat pad is an essential anatomic structure in the esthetic presentation of the face. It may become hypertrophied, with fullness of the cheek, or atrophic, with a sunken appearance, or become a plus or minus factor in reconstruction in this area. Lipoma of this pad is extremely rare, but it must also be differentiated. There are, therefore, certain circumstances where the presence or absence of the buccal fat pad can create a specific imbalance and asymmetry in the face. The correction of these conditions may require reduction or augmentation. The anatomy, the risks, the classification, and the various surgical techniques that are available to accomplish this are outlined and correlated to the masseter muscle transfer. ( Arch Otolaryngol Head Neck Surg 1988;114:287-290)

2015

Background The use of the Buccal Fat Pad (BFP) as a pedicled graft in the closure of intra-oral defects after oncological resections has gained in popularity, it is probably due to the ease of access, the rich blood supply and the low morbidity. The purpose of this study is to show our clinical experience and the results related to the use of the BFP in the repair selective malignant lesions of the oral cavity. Material and methods This study included a series of 31 patients, from January 2001 to January 2009, with BFP primary reconstruction after medium intraoral malignant lesions excision. After tumors excision, the BFP was gently exposed in the region of the molars by blunt dissection with the goal of keeping the fascial envelope intact and to preserve BFP vascular supply. The graft is then sutured covering the defect margins by interrupted resorbable sutures (Figure 1). The success criterion was the complete epithelialization of the graft and the absence of the graft’s infection and fistulae occurrences. All the patients underwent primary closure of defects with the buccal fat pad. Four patients who underwent the operation also had adjuvant radiotherapy. Patients underwent one year follow-up.

The buccal fat pad has been frequently used for the closure of oro-antral and oro-nasal communications. There are a few studies in the literature reporting its use in defects secondary to tumoral resections. In this paper we consider both the anatomical basis and the surgical technique. We also review 30 cases, used for the repair of 15 defects due to tumoral resections, 8 to maxillary cysts, 6 to communications and 1 secondary to a postraumatic defect. It has been successful in 28 of the 29 patients, with a complete epithelization of the flap, even in 4 cases with partial necrosis of the pad. It is an acceptable type of reconstruction, versatile and of a simple surgical technique. However, its use is limited to small or medium defects, being sometimes scarce.

We evaluated the chondrocyte differentiation potential of dedifferentiated fat cells (DFATs) and adipose stem cells (ASCs) from the human buccal fat pad (BFP). We isolated the cells from two patients who underwent oral and maxillofacial surgery. Chondrocyte differentiation was evaluated based on gene and protein expression analysis in addition to histological analysis of DFATs and ASCs seeded in an atelocollagen sponge and cultured for up to 21 days. The gene expression levels of chondrocyte differentiation markers such as aggrecan, collagen type 2, and SOX9 were higher in DFATs than in ASCs cultured for 14 and 21 days, whereas protein expression levels were higher in DFATs at all time points tested. Additionally, the levels of the embryonic stem cell markers Nanog, SOX2, and OCT4 were higher in DFATs than in ASCs at 72 h. The extracellular matrix of both the cultured ASCs and DFATs was Alcian blue-positive, indicating production of sulfated glycosaminoglycans, and was aggrecan-positive. The chondrocyte differentiation ability of human DFATs was higher than that of ASCs. Isolation of DFATs from the BFP offers an aesthetic advantage, as the BFP can be obtained from the oral cavity without surface scarring. Therefore, we propose that BFP-derived DFATs are an ideal cell source for cartilage tissue engineering. This study provides evidence that DFATs from the BFP are an ideal cell source for cartilage tissue engineering., 2014年度

Objectives: To determine the efficacy of the pediculate flap with the buccal fat pad in the sealing of orosinusal communications, describe the surgical technique used, and report the main complications. Patients and method: A retrospective study was made of 8 patients seen in the Service of Oral Surgery of the University of Barcelona Dental Clinic (Spain) for the treatment of orosinusal communications between the years 2007 and 2009. In all cases a pediculate flap with the buccal fat pad was used to solve the problem. Results: All of the orosinusal communications were successfully resolved with this technique. The immediate postoperative complications were pain (37.5%), inflammation (37.5%), edema (32.5%), trismus (37.5%), halitosis (14.3%), suppuration (12.5%) and rhinorrhea (12.5%). Conclusions: The use of Bichat?s buccal fat pad is not regarded as the technique of choice for sealing small to medium sized orosinusal communications. However, in the case of large communications, it is a good option, and the results obtained are optimum.

Michael V. Elam, MD, Newport Beach, Calif, and Erich A. Breisch, MD, and Terence Davidson, MD, San Diego, presented an article on liposuction of the buccal fat pad at the recent spring meeting of the American Academy of Facial Plastic and Reconstructive Surgery in Denver. Regional anatomy was first described using line drawings, pictures of cadaver dissections, and computed tomography. A videotape of the surgical technique was then shown. An intraoral approach is used, placing the suction cannula through a gingival sulcus incision and directing it posteriorly. The suction machine is then turned on, and the cannula is withdrawn slowly. The authors state that the procedure can be performed under local or general anesthesia, and that 10 to 20 mL of fat are usually extracted. Their most common postoperative problem was facial swelling. The primary indication for the procedure is cosmetic improvement of patients with round facies. The procedure gives

A male patient aged 51 years was referred for the treatment of a buccosinusal fistula of six months duration after removal of the upper left second molar. The patient complained of pain, a bad taste in the mouth and a feeling of fluid in the nose after drinking any beverage.Examination of the mouth revealed a 1 cm fistula in the bottom of the upper left sulcus, which contained pus. Computed tomographic 3D reconstruction demonstrated the bone defect and its proportion (Figure 1E, 1G).Preoperative antimicrobial therapy was started to control the infection, after which surgery was scheduled.Anesthesia involved a block of the upper posterior and middle alveolar nerves and the greater palatine nerve. An incision was made around the fistula and two other relief incisions were also made (Figure 1A). The bone defect was visualized, the necrotic tissue was removed from the bone rims and abundant irrigation was made with saline and an ampule of rifamycin (Rifocina® 75mg/1.5ml). An incision was made on the periosteum, the tissue was dissected and the buccal adipose body was rotated to the defect, covering it fully with no tension (Figure 1B). The buccal adipose body was sutured to the rim of the palatine and vestibular mucosa with 4/0 chrome catgut (Figure 1C). The mucosal flap was repositioned over the adipose tissue and similarly sutured. (Figure 1D).Postoperative medication included antimicrobials for preventing infection and the usual wound care measures.Seven days later the wound was closed, the adipose tissue was healing, and the patient reported that the symptoms were generally sub-siding. Twenty days after surgery, the mucosa was well positioned over the fully healed area and there was a slight excess fat tissue, which was removed in a second procedure.One year after surgery, computed to-mographic 3D reconstruction showed that the bone defect in the lateral wall of the maxillary sinus had regressed. (Figure 1F, 1H)