頬脂肪体を用いた顎口腔再建術の有用性に関する検討

Applicability of buccal fat pad grafting for oral reconstruction

ObjectivesAn oroantral fistula (OAF) is an abnormal connection between the oral cavity and the maxillary sinus. The buccal fat pad (BFP) has been used as a pedicle graft for the repair of oral cavity defects, including OAF defects. In the present study, we evaluated the effectiveness of the BFP technique for closing OAFs resulting from dental implant removal.Patients and MethodsBFP grafting was performed in patients with OAFs after dental implant removal, and the results were retrospectively analyzed. Nine patients were included, and the BFP was grafted onto the posterior maxilla for closure of the OAF.ResultsIn seven patients (82%), the OAF was successfully closed only in the first surgery, but in two patients, the OAF was not closed; therefore, additional surgery was performed. All patients with OAF after dental implant removal were successfully treated with the BFP graft without other serious complications.ConclusionOverall, this study highlights the clinical significance of BFP grafting for the management of OAFs following dental implant failure and suggests that BFP grafting can be considered a primary treatment option for patients presenting with OAFs.

The use of buccal fat pad (BFP) as a pedicled graft in cleft palate surgery

Introduction:The occurrence of gingival recessions (GRs) is multifactorial, mainly due to trauma induced by traumatic toothbrushing, orthodontic tooth movement, as well as anatomical factors such as bone dehiscence, teeth malposition, and muscle pull. Fat tissue in the oral cavity is widely available and easily accessed. The use of pedicled buccal fat pad (BFP) graft is well known in maxillofacial surgery and has been shown promising results, becoming safe and effective graft for several clinical applications. However the use of fat tissue harvested from the buccal fat pad as a free graft (BFFP) is less common, but recently, it has been described by the author for different intraoral clinical applications. The aim of this study is to present additional application using the BFFG for coverage of severe muco-GRs and to discuss the promising outcomes of this procedure.Patients and Methods:A technique for harvesting intraoral BFFG for the use in mucogingival surgery is presented. A total of 10 patients (age: 38.3 ± 6.8 years) with 17 teeth presenting severe GRs (4.8 ± 1.8 mm) were included in the study. Recessions treated using BFFGs were recorded at baseline and 12 months after surgery.Results:A total of 17 GRs were treated using BFFG. At 12 months, significant reduction of recession occurred. Initial recession was reduced from 4.8 ± 1.8 mm to 1.7 ± 0.9 mm. A mean of 3.1-mm reduction in GR was achieved compared to baseline.Conclusions:The new, simple, technique for treatment of severe GRs using BFFG resulted in significant reduction of GRs.

The buccal fat pad has been widely used for the repair of oral defects including treatment of patients suffering from trismus caused by oral submucous fibrosis is reported. This study has been conducted on 10 patients who underwent incision of the fibrotic bands and coverage of the buccal defect with a buccal fat pad graft. The surgical technique is described below, and the results suggest that this is a satisfactory, convenient, and reliable technique for the treatment of oral submucous fibrosis.

Sir: Small facial soft-tissue contour deformities are usually corrected via the transfer of autogenous lipoaspirate, due to the small volumes and precision required. The popular use of lipoaspirate is not without complications, including volume resorption, difficulty in achieving a three-dimensional conformational shape, and the possibility of fat embolism.1 The main reason for delayed absorption of aspirate is well known to be trauma during the aspiration procedure. In this article, we introduce the free buccal fat pad graft as an alternative to correct these small-volume facial deformities. Because the fat structure is well preserved, it is able to maintain its volume and consistency. The anatomy of the buccal fat pad should be well understood, in order to minimize donor-site complications and ensure minimal damage to the fine lobular architecture of the fat pad. The buccal fat pad graft is harvested via a single, intraoral buccal incision. The opening of Stenson’s duct is identified, and the buccal incision is placed away from the duct orifice at the level of the mandibular occlusal line. The buccinator muscle is split using blunt dissection, and the encapsulated buccal fat pad is delivered, with external digital pressure. Care is taken to avoid damaging the capsule of the fat pad. All 15 cases were performed by a single surgeon (Table 1). There were no donor-site complications. There were no cases of cheek contour deformity. All 15 patients reported excellent satisfaction with regard to contour deformity correction at 3-year follow-up. The buccal fat pad has been a subject of analysis for a variety of procedures since 1998.2 Emphasis has been placed on its use in intraoral defects. It has also been removed for cosmetic purposes, used to soften bony contours,2,3 and used as an interpositional graft over the facial nerve to prevent Frey’s syndrome.4 There are many clinical applications of the buccal fat pad graft, such as the correction of periorbital contour depressions, volume replacement after eyelid or nasal tip operations, interpositional graft over the facial nerve, and shield graft in the nasal tip after implant placement, especially in revision cases. In cases of silicone implant exposure, the buccal fat pad graft serves as a barrier to prevent skin thinning (Fig. 1).Fig. 1: An example of where the buccal fat pad graft would be useful. (Above) Nasal tip silicone implant infection and exposure. (Center) Buccal fat pad graft used to correct deformity and as a soft-tissue barrier. (Below) Excellent skin quality 6 months postoperatively.The main reason for fat resorption is known to be trauma during the fat aspiration. The buccal fat lobule, being well encapsulated in a multilobular form, maintains its structure and consistency, which helps to prevent its resorption.2,5 This allows it to be relatively robust in resisting fat resorption and to efficaciously restore volume in a three-dimensional conformation (Fig. 2); in contrast, lipoaspirate tends to conform to the soft-tissue pocket. It also obviates any possibility of fat embolism. Much attention has to be paid to surgical technique in harvesting the buccal fat pad. It is important that the capsule is not disrupted by poor surgical technique (Fig. 2). Damage to the capsule results in a higher rate of volume resorption after grafting.Fig. 2: Three-dimensional structure of the buccal fat pad makes it an excellent substrate for volume restoration.In conclusion, the buccal fat pad graft represents an easy and convenient tool for the correction of small facial contour deformities, volume replacement, aesthetic nasal tip augmentation, and revision rhinoplasty with minimal donor-site morbidity. DISCLOSURE The authors have no financial interest to declare in relation to the content of this article. Jeong Tae Kim, M.D., Ph.D. Department of Plastic and Reconstructive Surgery College of Medicine Hanyang University Seoul, Korea Samuel Yew Ming Ho, M.B.B.S.(Sing.) Section of Plastic Reconstructive and Aesthetic Surgery Department of General Surgery Tan Tock Seng Hospital Singapore Jin Hee Hwang, M.D. Department of Plastic and Reconstructive Surgery College of Medicine Hanyang University Seoul, Korea Kun Yong Sung, M.D. Department of Plastic and Reconstructive Surgery Kangwon National University Hospital Chuncheon City, Korea

Oro-antral communication is a complication associated with extraction of maxillary posterior teeth, surgeries of the maxillary sinus or pathologies associated with the sinus or the posterior maxilla. Such abnormal communications need to be repaired at the earliest, to maintain oral and nasal complex harmony and to prevent undue complications thereafter. These communications can be repaired by various methods, one of those being buccal fat pad pedicled graft technique which will be clinically evaluated and critically discussed in this paper. The pre-operative, immediate and post-operative measures followed, the eligibility criteria chosen, and the duration of follow up period, will formulate the outline for the study. A careful assessment of the criteria, clinical signs and healing is noted, to establish the outcome of the technique.

Coronoidectomy, masticatory myotomy and buccal fat pad graft in management of advanced oral submucous fibrosis

Published studies regarding Bichat fat pad focused, quite exclusively, on the implant of this adipose depot for different facial portions reconstruction. The regenerative components of Bichat fat pad were poorly investigated. The present study aimed to describe by an ultrastructural approach the Bichat fat pad, providing novel data at the ultrastructural and cellular level. This data sets improve the knowledge about the usefulness of the Bichat fat pad in regenerative and reconstructive surgery.Bichat fat pads were harvested form eight patients subjected to maxillofacial, dental and aesthetic surgeries. Biopsies were used for the isolation of mesenchymal cell compartment and for ultrastructural analysis. Respectively, Bichat fat pads were either digested and placed in culture for the characterization of mesenchymal stem cells (MSCs) or were fixed in 2% glutaraldehyde and processed for transmission or scanning electron microscopy. Collected data showed very interesting features regarding the cellular composition of the Bichat fat pad and, in particular, experiments aimed to characterized the MSCs showed the presence of a sub-population of MSCs characterized by the expression of specific markers that allow to classify them as multilineage differentiating stress enduring cells. This data set allows to collect novel information about regenerative potential of Bichat fat pad that could explain the success of its employment in reconstructive and regenerative medicine.

The use of a pedicled buccal fat pad graft for bone coverage in primary palatorrhaphy: A case report

New Graft-Stabilizing Clip as a Treatment Adjunct for Oral Submucous Fibrosis

La graisse de la face : anatomie descriptive et fonctionnelle à partir d'une revue de la littérature et de dissections de dix hémifaces

Odontogenic Sinusitis, Oro-antral Fistula and Surgical Repair by Bichat's Fat Pad: Literature Review

Six baby’s with cleft are born in Indonesia every hour. There is no standardized treatment of cleft in East Indonesia. Closure is an important aspect during cleft lip and palate surgery. Various techniques have been advocated to gain tissue for closure of cleft area. Mostly these techniques may only provide a small amount of additional length. For lager defects they may be use the local flaps or the buccal fat pad flap. The aim of this study is gain more information about intraoperative and early postoperative complications using the buccal fat pat during cleft palate surgery in East Indonesia. The mouth can be divided in six parts therefor the LAHSAL index will be used. This LAHSAL system is a diagrammatic classification of cleft lip and palate. The LAHSAL system is being used for this study as this system classifies the cleft primarily on location and also on the cleft being complete or incomplete, which can be significant for the research. After diagnosis and classification, the following patient data was obtained: patient age, weight, gender, type of surgery (primary or following, i.e. when the surgery is a correction of a previous treatment), if a bone graft is needed for closure, history of maxillofacial surgery or orthodontics, operation technique, operation duration, type of an aesthesia (local or general), radiographical records and light photos. These data were collected during the pre-operative consultation, about 24 hours before surgery. It was the policy of the team to admit and see all patients one day prior to surgery for counselling, postoperative instructions and evaluating the patient's facial defect.

The aim of this study is to describe the surgical technique, indications, advantages, and possible complications of the buccal fat pad flap and to report our clinical experience with this flap for intraoral reconstruction after tumor removal. The flap has been used to reconstruct oral defects after tumor resection in 32 patients, who have been retrospectively analyzed. Adequate closure of the defect was achieved during surgery in all cases. In one case, there was partial loss of the flap; this was treated conservatively. In five cases there was some retraction in the reconstructed area. Buccal fat pad as a flap offers an adequate reconstructive option to be born in mind when reconstructing small to medium defects in the oral cavity. It is a simple and quick surgical technique with a low incidence of complications.