versatility of buccal fat pad Dr. Susmitha Kandregula Anatomy and applications of Buccal fat pad

1. VERSATILITY OF BUCCAL
FAT PAD
BY
Dr.Susmitha Kandregula
Oral and Maxillofacial surgeon

2. INTRODUCTION
O Lorenz Heister(1727 )- identified the buccal fat
pad (BFP).
O Initially named as “glandula molaris” in
Compendium Anatomicum.
O 1801-Marie-Francois-Xavier Bichat gave the
anatomic description of the BFP as a fatty
tissue(boule de Bichat).
O bolle graisseusse in French
O wangenfettpafropf or Wangenfettpolster
(Wangen =Cheek +fett=fat, polster=pad-
cheek, fat, pad) in German
O Corpus adiposum buccae in Latin
O Sucking pad, sucking cushion, masticatory fat
pad, gliding pad or buccal pad of fat in English
ORAL ANATOMY- HARRY SICHER(3rd EDITION)
Singh J, Prasad K, Lalitha RM, Ranganath K. Buccal pad of
fat and its applications in oral and maxillofacial surgery: a
review of published literature (February) 2004 to (July) 2009.
Oral Surgery, Oral Medicine, Oral Pathology,
Oral Radiology, and Endodontology.
2010 Dec 1;110(6):698-705.

3. O It is a misnomer to call it buccal fat, rather it would
be appropriate to call it as a masticatory pad.
O Buccal fat is a specialized fat termed as syssarcosis.
O Mean volume
 Males-10.2ml(7.8-11.2)
 Females-8.9ml(7.2-10.8)
o Mean thickness-6mm
o Mean weight-9.7gm
o Harvested flap can cover defects upto 7x4x3cm.
Stuzin JM, Wagstrom L, Kawamoto HK, Baker TJ, Wolfe SA.
The anatomy and clinical applications of the buccal fat pad.
Plastic and reconstructive surgery. 1990 Jan 1;85(1):29-37.

4. EMBRYOLOGY
• Undifferentiated fat tissue without condensation
STAGE-1
• Vascular invasion/angiogenesis
STAGE-2
• Development of mesenchymal lobules
STAGE-3
STAGE-4
STAGE-5 •Definitive fat lobules
•Appearance of primitive fat lobules
Poissonet CM, Burdi AR, Bookstein FL (1983) Growth and
development of human adipose tissue during early
gestation. Early Hum Dev 8:1–11

5. ANATOMY
RELATIONS
Yousuf S, Tubbs RS, Wartmann CT, Kapos T, Cohen-Gadol AA, Loukas M.
A review of the gross anatomy, functions, pathology, and clinical uses of the
buccal fat pad. Surgical and radiologic anatomy. 2010 Jun 1;32(5):427-36.
Kahn JL, Sick H, Laude M, Koritke JG. Le corpus
adiposum buccae (boule de Bichat). Cells Tissues
Organs. 1988;132(1):41-7.

6. LIGAMENTS

7. Zhang H-M, Yan Y-P, Qi K-M, Wang J-Q, Liu Z-F (2002) Anatomical
structure of the buccal fat pad and its clinical adaptations.
Plast Reconstr Surg 109:2509–2518

8. FUNCTIONS
O Suckling
O Enhances intermuscular motion
O Protects and cushions the neurovascular bundle
O Invests spaces-Pterygomandibular,
infratemporal,anteparotid spaces and
submandibular gland fossa.
O Aesthetics.
Racz L, Maros TN, Seres-Sturm L. Structural characteristics and functional significance of the buccal fat pad
(corpus adiposum buccae). Morphologie et embryologie. 1989 Apr 1;35(2):73-7.
Tostevin PM, Ellis H. The buccal pad of fat: a review. Clinical Anatomy: The Official Journal of the American
Association of Clinical Anatomists and the British Association of Clinical Anatomists. 1995;8(6):403-6.

9. APPROACHES
O Superior gingivobuccal sulcus
incision
O Buccal mucosal incision below the
parotid duct(Matarasso’s method)
O Behind the parotid duct
opening(Stuzin’s method)
O Endoscopic
O Face lift
Markey J, Benet A, El‐Sayed IH.
The endonasal endoscopic harvest
and anatomy of the buccal fat pad
flap for closure of skull base defects.
The Laryngoscope. 2015 Oct;125(10):2247-
52.
Dubin B, Jackson IT, Halim A, Triplett WW, Ferreira M. Anatomy of the buccal fat pad and its clinical significance. Plastic and reconstructive
surgery. 1989 Feb;83(2):257-64.

10. APPLICATIONS

11. 1.Oro-antral fistula
Manuel S, Kumar S, Nair PR. The versatility in the use of buccal fat pad
in the closure of oro-antral fistulas. Journal of maxillofacial and oral
surgery. 2015 Jun 1;14(2):374-7.
Egyedi P. Utilization of the buccal fat pad for closure of oro-antral and/or
oro-nasal communications. Journal of maxillofacial surgery. 1977 Jan
1;5:241-4.

12. THREE LAYERED CLOSURE
Darr A, Jolly K, Martin T, Monaghan A, Grime P,
Isles M, Beech T, Ahmed S. Three-layered
technique to repair an oroantral fistula using a
posterior-pedicled inferior turbinate, buccal fat pad,
and buccal mucosal advancement flap.
British Journal of Oral and Maxillofacial Surgery.
2018 Sep 1;56(7):638-9.

13. 2.ORAL SUBMUCOUS FIBROSIS
Thukral H, Chowdhury SK, Nagori SA. Surgical management of oral submucous
fibrosis using buccal fat pad: a retrospective study of 30 cases.
Oral and Maxillofacial Surgery. 2018 Dec 1;22(4):403-8.

14. 3.PALATAL FISTULA
Ashtiani AK, Fatemi MJ, Pooli AH,
Habibi M. Closure of palatal fistula
with buccal fat pad flap. International
journal of oral and maxillofacial
surgery. 2011 Mar 1;40(3):250-4.

15. 4.CLEFT PALATE
Levi B, Kasten SJ, Buchman SR. Utilization of the buccal fat pad flap for congenital
cleft palate repair. Plastic and Reconstructive Surgery. 2009 Mar 1;123(3):1018-21.

16. 5.PALATAL
DEFECT
De Riu G, Meloni SM, Bozzo C, Meloni F, Tullio A. A double
buccal fat pad flap for middle palate defect closure—a new
technique for palate closure. International journal of oral and
maxillofacial surgery. 2006 Nov 1;35(11):1057-9.

17. 6.SOFT PALATE LENGTHENING
Khouw YL, van der Wal KG, Bartels F, van der Biezen JJ. Bilateral palatal reconstruction using 2 pedicled
buccal fat pads in rhinolalea aperta after extensive necrotizing tonsillitis: a case report. Journal of oral and
maxillofacial surgery. 2004 Jun 1;62(6):749-51.

18. 7.OSTEONECROSIS
Melville JC, Tursun R, Shum JW, Young S, Hanna IA, Marx RE. A
technique for the treatment of oral–antral fistulas resulting from
medication-related osteonecrosis of the maxilla: the combined buccal
fat pad flap and radical sinusotomy. Oral surgery, oral medicine, oral
pathology and oral radiology. 2016 Sep 1;122(3):287-91.

19. 8.TEMPOROMANDIBULAR
JOINT ANKYLOSIS
Singh V, Dhingra R, Sharma B, Bhagol A, Kumar P. Retrospective analysis of use of buccal fat pad as
an interpositional graft in temporomandibular joint ankylosis: preliminary study. Journal of oral and
maxillofacial surgery. 2011 Oct 1;69(10):2530-6.
Dimitroulis G. The interpositional dermis-fat graft in the management of temporomandibular joint
ankylosis. International journal of oral and maxillofacial surgery. 2004 Dec 1;33(8):755-60.

20. Traumatic Myositis
Ossificans
Rattan V, Rai S, Vaiphei K. Use of buccal pad of fat to
prevent heterotopic bone formation after excision of
myositis ossificans of medial pterygoid muscle. Journal
of oral and maxillofacial surgery. 2008 Jul 1;66(7):1518-
22.

21. 9.SINUS FLOOR
AUGMENTATION
Hassani A, Khojasteh A, Alikhasi
M, Vaziri H. Measurement of
volume changes of sinus floor
augmentation covered with
buccal fat pad: a case series
study. Oral Surgery, Oral
Medicine, Oral Pathology, Oral
Radiology, and Endodontology.
2009 Mar 1;107(3):369-74.

22. 10.ORTHOGNATHIC SURGERY
Rubio-Bueno P, Ardanza B, Piñas L, Murillo N. Pedicled
buccal fat pad flap for upper lip augmentation in
orthognathic surgery patients. Journal of Oral and
Maxillofacial Surgery. 2013 Apr 1;71(4):e178-84.

23. 11.AESTHETIC AUGMENTATION
Kim JT, Sasidaran R. Buccal fat pad: an effective option
for facial reconstruction and aesthetic augmentation.
Aesthetic Plastic Surgery. 2017 Dec 1;41(6):1362-74.

24. 12.ADIPOSE STEM CELLS FROM
BUCCAL FAT PAD
O ASCs from BFP differentiate to chondrocytes, osteoblasts,
or adipocytes
O BFP can be a rich alternative source of stem cells, readily
available for clinical application in the field of tissue
engineering for the repair of bone and cartilage defects.
Farré-Guasch E, Martí-Pagès C, Hernández-Alfaro F, Klein-Nulend J, Casals N. Buccal fat pad, an oral
access source of human adipose stem cells with potential for osteochondral tissue engineering: an in
vitro study. Tissue Engineering Part C: Methods. 2010 Oct 1;16(5):1083-94.

25. Singh J, Prasad K, Lalitha RM, Ranganath K. Buccal pad of fat and its applications in oral and maxillofacial surgery: a review of published literature (February) 2004 to (July) 2009. Oral
Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and Endodontology. 2010 Dec 1;110(6):698-705.

26. Singh J, Prasad K, Lalitha RM, Ranganath K. Buccal pad of fat and its applications in oral and maxillofacial surgery: a review of published literature (February) 2004 to (July) 2009. Oral
Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and Endodontology. 2010 Dec 1;110(6):698-705.

27. THANK YOU