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The purpose of the present study was to identify histological biomarkers that could be used to predict adipose tissue invasion by oral squamous cell carcinoma (OSCC). The medical records and preoperative computed tomography scans of patients with primary OSCC with suspected buccal fat pad invasion were retrospectively reviewed, and an immunohistochemical study of candidate predictive biomarkers of adipose tissue invasion (α-SMA, E-cadherin, N-cadherin, FABP4, Col VI, and MMP-11) was carried out. Thirty OSCC patients whose tumors were suspected to be in contact with the buccal fat pad based on preoperative imaging were included in this study. Of these, infiltrative adipose tissue invasion was histopathologically confirmed in 6 patients (20.0 %). The significant higher immunoreactivity of candidate predictive biomarkers was detected in the tumor-buccal fat pad contact area compared to in the tumor surface area.(Pearson’s correlation coefficient test: α-SMA: 0.422, p

After en bloc resection of the maxilla or mandible, surgeons may choose to replace the missing bone and soft tissue with a fibula free flap (FFF). One of the complications that may arise during the healing of a FFF is heterotopic ossification along the free flap pedicle. Heterotopic ossification is most often noted incidentally on post-operative radiographs and rarely creates a functional deficit. Subperiosteal dissection of the pedicle from the bone during the harvest of the FFF is believed to be the main contributing factor that leads to this formation of bone along the flap soft tissue. Pain or limitation of movement of the jaws, depending upon where heterotopic bone forms are related functional issues. Changes in facial appearance due to expansion related to this phenomenon of bone deposition may also occur. This paper presents a patient that developed a functional deficit secondary to heterotopic ossification of a FFF that required surgical intervention The goal of our surgery was to maintain the blood supply to a vascularized flap while removing the heterotopic bone. We will present the unique aspects of planning this challenging surgery: Case A 40-year-old man with a history of right posterior maxillary ameloblastoma underwent a hemi-maxillectomy with fibula free flap reconstruction. The patient developed extracapsular heterotopic bone ankylosis beginning 2 months postoperatively developing severe trismus and required surgical intervention. Radiographic imaging revealed extensive heterotopic ossification of the vascular pedicle that extended from the most proximal positioned end of the fibula to the inferior lateral border of the mandible. A radiographic CT with contrast imaging revealed an intact vascular pedicle with surrounding heterotopic bone. Virtual planning and stereolithic modeling were utilized to plan the heterotopic bone removal. In the operating room, we removed the heterotopic bone in small segments according to the virtual plan to avoid injuring the vascular pedicle. A coronoidectomy was also performed to help gain more range of motion. An adipofascial flap using the buccal fat pad was raised into the area of defect to prevent future recurrence. The patient was put on a strict physical therapy regimen to help regain his range of motion. Conclusion Heterotopic ossifications along free flap pedicles are a known complication of the FFF. A conservative management approach should be used since most postoperative patients will be asymptomatic and findings are incidental on post-op imaging. Surgery should be reserved for symptomatic patients. Heterotopic ossification needs to be considered as a differential in a microvascular reconstruction postoperative patient when the patient presents with a slow onset of facial swelling, neck mass, or trismus. Virtual planning is an essential tool in the surgeon’s planning armamentarium dependent upon the timing of the procedure so that the vascular integrity of the flap can be protected after the initial anastomosis.

There is limited knowledge about masticatory function after the release of temporomandibular joint (TMJ) ankylosis. In this study, masticatory function was evaluated by measuring maximum voluntary bite force (MVBF) and chewing efficiency in 30 unilateral TMJ ankylosis patients who were treated with buccal fat pad (BFP) interpositional arthroplasty. Eighteen subjects over 12 years of age were included in study Group A and 12 subjects below 12 years of age in study Group B. Patients in the study groups had completed a minimum follow up of one year after surgery. Control groups C (over 12 years of age, n = 18) and D (under 12 years of age, n = 12) consisted of age, sex, and weight-matched normal subjects. The mean MVBF was measured between occluding molar teeth with a strain gauge transducer. Chewing efficiency was measured with two different coloured chewing gum strips. These were chewed for 5, 10, 20, 30, and 50 strokes. Compared with normal subjects, the study groups (A and B) could generate 64.7% (p = 0.004*) and 89.8% (p = 0.121) of MVBF, respectively. Overall chewing efficiency was 88.7% in Group A and 92.9% in Group B (p = 0.014* and p = 0.138, respectively) when compared with normal subjects. The study has shown that BFP interpositional arthroplasty effectively restores masticatory function.

Objective: There are many reconstruction techniques for the repair of the intraoral buccal defects following oncological resections. The pedicled buccal fat pad (BFP) flap can be used for reconstruction of medium-sized buccal defects. The purpose of this study was to investigate the outcomes of the reconstruction with BFP flap following the resection of buccal tumors and risk factors on BFP flap success. Methods: This study was designed as a retrospective case series research. Ten patients with squamous cell carcinoma of the buccal mucosa underwent BFP flap reconstruction following tumor resection. The dimensions of the primary tumor and post-resection defect were calculated. The intraoral operation field was evaluated on the postoperative 7th day and in the postoperative 1 st and 6th months. Postoperative flap status, disease recurrence, risk factors for flap success were assessed. Results: The mean greatest dimension of the post-resection buccal defect was 41.9 +/- 10.3 mm. A partial dehiscence was observed in three patients in the postoperative 7th day. The 6th month-examination revealed no flap complications. The mean greatest dimension of post-resection buccal defect in uncomplicated patients was 42.7 +/- 11.4 mm and in patients with partial dehiscence was 40 +/- 8.6 mm (p = 0.727). There was no significant difference between uncomplicated patients and patients with partial dehiscence according to body mass index (normal vs overweight, p = 0.667). Conclusion: The BFP flap is a reliable reconstruction method in medium sized buccal defects following oncological resection. It has low complication and donor site morbidity rates and also good anatomical and oncological outcomes. (C) 2021 Asian AOMS, ASOMP, JSOP, JSOMS, JSOM, and JAMI. Published by Elsevier Ltd. All rights reserved.

Buccal fat pad removal or bichectomy is an esthetic surgical procedure that is gaining notoriety and increasing number worldwide. This paper aims to discuss the effectiveness of bandage in bichectomy postoperative concerning major complications like bleeding and subcutaneous emphysema. This is a retrospective case series according to PROCESS guidelines of 643 bichectomy surgeries performed by two different surgeons with the same technique from January 2018 until December 2020. Effectiveness of bandage is evaluated in complications rate decrease with statistical tests (p

Background: Oroantral fistula(OAF), the most common complication after extraction of posterior maxillary teeth leading to chronic maxillary sinusitis, patient discomfort and can cause difficulty in speech, mastication, and overall hygiene of the patient. Many treatment approaches have been developed to treat OAFs; Buccal Fat Pad (BFP) as a graft material, Buccal Advancement flap (BAF) and rotational palatal flap(RPF). Aim: To compare two treatment modalities for the management of Oroantral Fistula (OAF). We compared the clinical outcomes for both Buccal Fat Pad (BFP) reinforce Buccal Advancement flap(BAF) and rotational palatal flap (RPF) treatment approaches. Material and Methods: A total of 76 patients were included in this randomized controlled clinical study and were divided into two groups; Group A: treated with BFP reinforce BAF, and Group B: treated with RPF. Both procedures were performed under local anesthesia. All the patients were assessed clinically by Valsalva test at 1 week and 4 weeks post-surgicalwhere the surgical siteswere examined by direct visual examination for the amount of both epithelization and closure of the OAF. Results: Our results showed no statistical significant difference (P>0.05) in the clinical outcomes of for both tested OAF treatments Conclusion: Both treatment approaches are good and dependable inthe management of OAF.

Objective: The present study was performed to evaluate the efficacy of buccal fat pad with sandwich graft versus buccal fat pad with bone block graft in closure of oroantral communication. Subjects and methods: Patients of the present study were selected from those attending the outpatient clinic of Oral and Maxillofacial Department at Faculty of Dental Medicine, Al Azhar University (Assiut Branch). Fourteen patients with oroantral communications were divided in two groups: (group I) treated with sandwich graft covered by buccal fat pad, and (group II) treated by bone block covered by buccal fat pad. Results: Closure of oroantral communication was successful in both groups. No patient had any infection, graft exposure and /or loss, soft tissue dehiscence. Radiographic analysis revealed significant increase in bone density fo both groups, (from 693.5 ± 28.61 immediately postoperative to 805.2 ± 28.06 after 9 months) for G (I) And (from 590.0 ± 30.24 immediately postoperative To 683.3 ± 16.59 after 9 months) for G (II). Also, there was significant decrease in bone height in bone height in both groups at 6 and 9 months. Conclusion: Closure of OAC with buccal fat pad and bone graft not only gives excellent soft tissue healing, but also compensate the underlying bone defect.

Aim of study: The aim of this study was to Compare the effectiveness of Non-pedicled buccal fat pad versus Platelet rich fibrin in treatment of Miller class II gingival recession using vistubular Incision Subperiosteal Tunnel Access TechniquePatients and methods:This study was conducted on 40 patients with class II gingival recession in anterior or premolar segment. The entire patients were selected from the out patient clinic of the Oral Medicine, Oral Diagnosis, and Periodontology Department. Faculty of Dentistry, Minya University.Forty patients with gingival recession class II were divided randomly into two groups:Group I: (20 defect) using VISTA technique with Non- pedicled buccal fat pad (NPBFP), Group II: (20 defect) using VISTA technique with platelet rich fibrin (PRF).Results: In both groups all clinical parameters were statistically significant from pre-operative period till 6 months follow up period. In the comparison between the two groups after 6 months follow up period, there were no statistically significant difference between two groups regarding all clinical parameters except percentage of root coverage; there was significant increase in percentage of root coverage after 3 and 6 months follow up period in group II with p value was less than 0.05.Conclusion: Both PRF membrane and NPBFP are effective in the management of Class II gingival recession defects using VISTA technique. PRF group has better results regarding percentage of root coverage than NPBPF group after 3 and 6 months follow up.

Primary palatoplasty for cleft palate places patients at high risk for scarring, altered vascularity, and persistent tension. Palatal fistulas are a challenging complication of primary palatoplasty that typically form around the hard palate–soft palate junction. Repairing palatal fistulas, particularly wide fistulas, is extremely difficult because there are not many choices for closure. However, a few techniques are commonly used to close the remaining fistula after primary palatoplasty. Herein, we report the revision of a palatal fistula using a pedicled buccal fat pad and palatal lengthening with a buccinator myomucosal flap and sphincter pharyngoplasty to treat a patient with a wide palatal fistula. Tension-free closure of the palatal fistula was achieved, as well as velopharyngeal insufficiency (VPI) correction. This surgical method enhanced healing, minimized palatal contracture and shortening, and reduced the risk of infection. The palate healed with mucosalization at 2 weeks, and no complications were noted after 4 years of follow-up. Therefore, these flaps should be considered as an option for closure of large oronasal fistulas and VPI correction in young patients with wide palatal defects and VPI.

The aim of the study was to evaluate the effectiveness of buccal fat pad (BFP) in the reconstruction of surgical defects following sequestrectomy in medication-related osteonecrosis of the jaws (MRONJ). A total of ten patients with MRONJ underwent sequestrectomy and reconstruction using BFP. There were 3 males and 7 females. The age range was 20-70 years. Two patients were diagnosed with stage 2, and eight patients were diagnosed with stage 3 disease. Eight defects were present in the maxilla and two in the posterior mandible. Oro-antral communication was present in 8 cases. All patients have undergone sequestrectomy, debridement and reconstruction using BFP under local anaesthesia. Postoperatively, the patients were followed up at 1, 3, 6 and 12 months and evaluated for complete epithelisation of defect, infection, pain and recurrence of the lesion. Complete epithelisation with closure of the defect was achieved in all the cases. None of the patients had residual pain or inflammation at the surgical site. There was no case of postoperative infection. Reconstruction using buccal fat pad is an effective treatment modality to provide symptomatic relief and to prevent further progression of disease in MRONJ patients.

Objective: The purpose of this study was to examine the surgical impact of the pedicled buccal fat pad (BFP) flap on the levator veli palatini (LVP) muscle and surrounding velopharyngeal (VP) anatomy following primary palatoplasty using magnetic resonance imaging (MRI). Design: Observational, prospective. Setting: MRI studies were completed at 3 different facilities. All participants with BFP flap were operated on by the same surgeon. Participants: Five pediatric participants with cleft palate with or without cleft lip (CP±L) who underwent primary palatoplasty with BFP flap placement. Comparison groups consisted of 10 participants: 5 with CP±L who did not receive the BFP flap and 5 healthy controls. Interventions: All participants underwent nonsedated MRI 2 to 5 years postoperatively. Main Outcomes and Measures: Anatomical measures of the velopharynx and LVP among the 3 participant groups. Results: Median values were significantly different among groups for velar length ( P = .042), effective velar length ( P = .048), effective VP ratio ( P = .046), LVP length ( P = .021), extravelar LVP length ( P = .009), and LVP origin–origin distance ( P = .030). Post hoc analysis revealed a statistically significant difference between the BFP and traditional repair groups for effective VP ratio ( P = .040), extravelar LVP length ( P = .033), and LVP length ( P = .022). Conclusions: This study provides preliminary support that the BFP flap creates a longer velum, with increased distance between the posterior hard palate and the LVP, and a larger effective VP ratio compared to traditional surgical techniques. Future research is needed to determine whether this procedure provides a more favorable mechanism for VP closure.

Background Buccal Fat Pad (BFP) excision has become an aesthetic surgical procedure. Although this procedure is quite common, it is important to bear in mind that the scientific evidence supporting the efficacy of this treatment is scarce and of low quality. The purpose of this systematic review was to analyse all relevant data to assess the efficacy and safety of BFP excision for improving midface aesthetics. Material and Methods A thorough search of MEDLINE (PubMed), Scopus and Cochrane Library databases was conducted. The PICO approach was used where healthy patients seeking cheek slimming and facial silhouette refining undergo BFP excision and were compared before and after surgery in terms of BFP volume reduction, adverse effects and patient satisfaction. Results Of the 1,413 references identified, 4 were included in the qualitative synthesis. Only one study reported BFP volume reduction, which was 3.10 mL (95%CI: 2.38 to 3.80; P < 0.001), and the mean volume of the excised tissue was 2.74 ± 0.69 mL (range, 1.8-4.9 mL). 84.6% of the patients stated that their facial contour was much better and the remaining 15.4% noticed that the appearance of their cheeks following BFP excision was better. Seven complications were reported in the 134 cheek refinement procedures. Conclusions BFP removal has an initially favorable outcome for facial aesthetics and a low postoperative complication rate, however, there are many procedures being performed with poor quality methodology and there is also a lack of published data on its long-term follow-up results. Key words:Buccal fat pad, buccal fat pad excision, surgery, plastic, aesthetics, cheek refinement, facial silhouette refining.

The objective of this study was to determine correlations between magnetic resonance imaging (MRI) features including radiologic depth of invasion (r-DOI) and pathologic DOI (p-DOI) of squamous cell carcinoma of the buccal mucosa.In total, 31 lesions were retrospectively evaluated. MRI findings included detectability, buccinator muscle invasion (positive: BMI+, negative: BMI-), buccal fat pad invasion (positive: BFPI+, negative: BFPI-), and r-DOI measured on T2-weighted images (T2-DOI) and contrast-enhanced T1-weighted images (CET1-DOI). These findings were compared to the p-DOI of the tumors.The p-DOI values of undetectable lesions were smaller than those of detectable lesions (P.001), and the cutoff value was 1 mm. BMI+ and BFPI+ lesions had significantly larger p-DOI values than the corresponding BMI- and BFPI- lesions (P.001), with cutoff values of 5 and 6 mm, respectively. The correlation coefficient between CET1-DOI and p-DOI was 0.68 (P.001). CET1-DOI values were larger than p-DOI (P.001) and the average difference between them was 3.4 mm. T2-DOI was inconclusive in 50% of cases. Interobserver agreements of MRI evaluation were good to very good.MRI-derived parameters were useful in estimating p-DOI and may be helpful in predicting the depth of invasion of tumors and the risk of lymph node metastasis.

This article presents an overview of the history of the buccal fat pad flap, its relevant anatomy, and its indications and contraindications. The surgical technique for its harvest is described, as are the postoperative care and possible complications.

Summary: Cleft lip and palate are the most widely recognized craniofacial congenital malformation. The buccal fat pad (BFP) can be utilized to close lateral fistulas at the time of palatoplasty due to its rich blood supply and simple accessibility. The aim is to report on the use of BFP as a pedicled flap in cleft palate surgery and to discuss promising results for this reconstructive concept. The case subject was a five-year-old male born with cleft lip and palate; the cleft lip was operated on 4 months old. The patient was operated on using Bardach's two flap palatoplasty techniques, and for the closure of the lateral lining defect, the BFP was used as a pedicled flap. After the surgery, no abnormality was found, including infection, graft loss, palatal fistulas, or cheek depression. All wounds were fully epithelialized. In palatoplasty, BFP is a safe and reliable method with a fast healing benefit.

Background: Oral submucous fibrosis is a treacherous, devastating state of the mouth bringing about critical wellbeing and social issues, which may meddle with the standard assessment of the oral depression for malignancy, satisfactory nourishing admission, dental cleanliness and discourse. Medicines proposed for OSMF have been palliative instead of remedial. They are pointed toward improving the patient’s capacity to open the mouth, which becomes confined when more scar tissue is shaped as the illness advances. Various unions are accessible today to cover the post fibrotic discharge deformity however none of them alone gave a drawn out victories. In our investigation we looked at two modalities as they were generally advantageous and convey less postoperative morbidity. Collagen sheet as a join to cover the careful deformity and the buccal cushion of fat turned onto the imperfection as a unite to cover it. Aims and Objectives: The current investigation was led to assess the clinical viability of collagen film and buccal cushion of fat join for careful administration of Oral Submucous fibrosis with extraction of third molars, two-sided coronoidotomy, masticatory muscle myotomy with arrival of fibrosis and remaking by collagen layer unite in five patients and buccal fat cushion join in five patients of clinically analyzed stage III, IV Oral Submucous fibrosis with a subsequent time of a half year from September 2010 to September 2012 at Department of Oral and maxillofacial Surgery in Al Badar Rural Dental College and Hospital. Materials and Methods: Ten patients with chief complaint of difficulty in mouth opening with no previous history of any medical or surgical line of treatment and clinically diagnosed as stage III, IV Oral submucous fibrosis were included in this study. Preoperative clinical findings, radiological investigations and maximum incisal distance were assessed for the need of surgical procedure for Oral submucous fibrosis. All the patients u

Located in the middle facial third, the buccal fat pad is a biconvex, rounded fat structure limited by a thin capsule. People with an excessive volume of the buccal fat pad may present either a childlike or overweight appearance; however, the surgical excision can sculpt the facial angles and improve facial aesthetics. Although this procedure (also called “bichectomy”) has become so popular nowadays, evidence and studies that provide guidelines concerning technical details are quite limited. Thus, this narrative literature review aimed to summarize as much information as possible regarding the excision of the buccal fat pad for aesthetic recontouring of the face. According to the studies evaluated, the surgical management of the buccal fat pad is considered a relatively simple procedure that presents excellent aesthetic results when properly indicated and performed by a professional experienced in the technique. However, considering the lack of high-level scientific evidence with regards mainly the long-term effects, well-designed studies with appropriate follow-up are still necessary for further clarification and, then, support the technique in the clinical routine. En el tercio medio de la cara se ubica un cuerpo adiposo en la mejilla, esta es una estructura adiposa redondeada, biconvexa, delimitada por una fina cápsula. Las personas con exceso de grasa en las mejillas pueden parecer infantiles o con sobrepeso, pero la extirpación quirúrgica puede esculpir los ángulos faciales y mejorar la estética general de la cara. Aunque este procedimiento (también conocido como “bichectomía”) se ha vuelto muy popular en estos días, la evidencia y los estudios que brindan detalles técnicos son bastante limitados. Por lo tanto, la presente revisión narrativa de la literatura tuvo como objetivo recopilar la mayor cantidad de información posible sobre la escisión del cuerpo adiposo de la mejilla con el fin de realizar un contorno facial estético. Según los estudios realizados, el manejo quirúrgico de este tejido adiposo puede considerarse un procedimiento relativamente sencillo que presenta excelentes resultados estéticos cuando está debidamente indicado y realizado por un profesional experimentado con la técnica. Sin embargo, considerando la falta de evidencia científica de alto nivel, principalmente relacionada con los efectos a largo plazo, aún son necesarios estudios bien diseñados con un seguimiento adecuado para una mayor claridad y justificación de la técnica en la rutina clínica. Localizado no terço médio da face, o corpo adiposo da bochecha é uma estrutura adiposa arredondada, biconvexa e delimitada por uma cápsula fina. Indivíduos com volume excessivo do corpo adiposo da bochecha podem apresentar uma aparência infantil ou de que estão em sobrepeso, porém a excisão cirúrgica é capaz de esculpir os ângulos faciais e melhorar a estética da face como um todo. Apesar deste procedimento (também conhecido como “bichectomia”) ter se tornado muito popular nos dias de hoje, as evidências e os estudos que fornecem detalhes técnicos são bastante limitados. Desta forma, a presente revisão narrativa da literatura teve como objetivo compilar o máximo de informações relativas à excisão do corpo adiposo da bochecha com finalidade de recontorno estético da face. De acordo com os estudos levantados, o manejo cirúrgico do corpo adiposo da bochecha pode ser considerado um procedimento relativamente simples e que apresenta ótimos resultados estéticos quando bem indicado e realizado por profissional experiente na técnica. Entretanto, considerando a carência de evidências científicas de alto nível principalmente relacionadas aos efeitos em longo prazo, estudos bem delineados e com seguimento apropriado são ainda necessários para maiores esclarecimentos e fundamentação da técnica no cotidiano clínico.

Background: Surgical procedures including palatoplasty have a risk for complications. The aim of this study was to investigate the intraoperative and early postoperative blood loss using the buccal fat pad (BFP) during cleft lip and/or cleft palate (CL/P) surgery. Material and Methods: This prospective study included a total of 109 patients with cleft palate (CP) during a three-month period of treatment at Hasanuddin University Dental Hospital (permanent center) and charity trips in rural parts of Eastern Indonesia. All patients were treated with DOZ Furlow technique combined with BFP graft. Before and after surgery, the total amount of intraoperative blood loss was calculated by measuring the weight differences of the gauze swabs that were used to control the surgical bleeding followed by a complete blood count at three days postoperatively. Results: The difference in the amount of blood loss based on age categories in charity groups was found to be significant (P

COVID-19 pandemic has been a major challenge for health care services all around the world. With increasing COVID-19 cases and lockdown enforcement, there has been a significant delay in the presentation of patients in the emergency department; also the fear in people of contracting COVID-19 from the hospital is an additional factor. The following case report describes such an incidence of delay in presentation of buccal fat pad injury patient to the emergency department.

Background Since 2007, when the anatomy of facial fat compartment was described, an increasing number of studies on the aging process of the compartment of cadavers has emerged. Objectives The authors evaluated the aging changes of lateral facial fat compartments on the same person. Methods Sixty-three patients were included in this retrospective study. All patients had magnetic resonance imaging scans with at least 4 years apart. The authors targeted the fat compartments of the superficial temporal, subcutaneous temporal, and buccal fat pad, comparing the data on different time points. Results The thickness of the subcutaneous temporal fat did not change significantly. The 3 diameters of the superficial temporal fat compartment all became thinner on the axial view (P < 0.05). On the sagittal view, the superficial temporal fat elongated from 38.89 mm to 43.74 mm (P < 0.05). The buccal fat compartment also lengthened from 68.73 mm to 74.39 mm (P < 0.05) and had a positive correlation with follow-up duration only. Conclusions The study revealed the fat compartment change on the same person with time. The temporal hollow mainly originates from the thinner part of the superficial temporal fat. The descending of the buccal fat pad aggravates the labiomandibular fold. By understanding the aging process more fully, we can rejuvenate our patients more naturally.

In the palatal defects due to surgical resection, flap selection is very important for a correct reconstruction. Different methods have been suggested over the time, however the pedicled buccal fat pad is a simple, effective, reliable flap for reconstruction after palate tumor resection. The aim of the present study is to introduce a new surgical technique for palate reconstruction with pedicled buccal fat pad flap exposing the advantages. The Authors performed this procedure in 17 patients in order to treat medium-sized oncologic surgical defect of palate region in the period between 2016 and 2019. Complete wound healing after only 4 weeks without complication after 12 months follow-up was observed. This is the first cases series described with this new technique.

Background Autologous abdominal fat grafts are occasionally used in the repair of skull base exposures. This surgical procedure typically requires an additional surgical site and may have unexpected postoperative complications. Objective To describe an operative technique for harvesting subfascial fat from the temporal extension of the buccal fat pad for the repair of skull base defects. Methods We review the pertinent anatomy of the temporalis subfascial fat pad and discuss the technique used to harvest the subfascial fat component in a clinical presentation. Results A pretemporal approach was performed for clip ligation of an anterior circulation aneurysm. A standard frontotemporal incision was made with an interfascial flap to preserve the frontalis branches of the facial nerve. The subfascial fat was inspected and determined to be adequate for harvesting. Monopolar cauterization was carefully utilized to remove the fat. During closure, the graft was used to repair a pneumatized clinoid sinus and for the dural repair of the pretemporal exposure. The patient did not have any postoperative complications. Conclusion Autologous temporalis subfascial fat graft is a viable and safe technique for skull base dural and sinus repair during frontotemporal approaches in select patients. This technique avoids an additional surgical procedure and potential complications that may be associated with it.

Background Incidence of Medication-Related Osteonecrosis of the Jaw (MRONJ) related to cancer and myeloma treatments is undetermined, with scarce data varying from 2 to 7.8/million/year in limited investigated populations. A 9-years [2009-2018] regional-wide survey was conducted, deploying the North-Western Italy Cancer Network (“Rete Oncologica Piemonte e Valle d’Aosta”), to assess number and main characteristics of MRONJ cases among myeloma/cancer patients, within a population of 4.5 million inhabitants. Material and Methods MRONJ cases were collected retrospectively from January 2009 to June 2015; from July 2015 to December 2018, data were collected prospectively. Number of new MRONJ cases per year, underlying disorder, drug(s) administered, treatment duration, site and onset timing of MRONJ were detailed. Results 459 MRONJ cases were identified. Primary diseases were breast cancer (46%), prostate cancer (21%), myeloma (19%), and other types of carcinoma (14%). Patients received antiresorptive treatment either alone (399; 88.47%) or in combination with biological agents (52; 11.53%); 8 patients (1.7%) received only antiangiogenic drugs. Zoledronic acid [388] and denosumab [59] were the most frequently administered drugs. Mandible was involved in 296 (64,5%) cases. Number of new MRONJ cases was stable from 2009 to 2015, with a mean of 51.3 cases per year (raw incidence: 11.6/million/year), declining in the 2016-2018 years to 33.3 cases per year (raw incidence: 7.5/million/year). Conclusions With such discrepancy of cases overtime being partially explicable, number of new MRONJ cases per year are consistent with those observed in a previous study [2003-2008] in the same region, being instead higher than those reported in other populations. Key words:Osteonecrosis of the jaw, bisphosphonates, zoledronic acid, denosumab, antiangiogenic drug, incidence.