Applicability of buccal fat pad grafting for oral reconstruction

Abstract

This study evaluated the applicability of pedicled buccal fat pad grafting for the reconstruction of defects surgically created during oral surgery. A buccal fat pad graft was applied in 23 patients (5 males, 18 females; mean age 68.3 years) between 2003 and 2011. The graft was used to cover surgical defects of the palate, maxilla, upper gingiva, buccal mucosa, lower gingiva, oral floor, and temporomandibular joint region. Size of the surgical defects ranged from 15 mm × 12 mm to 30 mm × 40 mm; size of the buccal fat pad ranged from 15 mm × 12 mm to 43 mm × 38 mm. A pedicled buccal fat pad was prepared by incising the maxillary vestibule following primary surgery, and the surrounding connective tissue was preserved to supply nutrition to the pedicle during surgery. The buccal fat pad was placed on the raw surface of soft tissue or bone surface and sutured to the surrounding tissue of the defect. Complete epithelialization was observed within 4 weeks postoperatively. There were no complications or functional disorders during follow-up. Buccal fat pad grafting appears to be feasible for the reconstruction of surgically induced defects, and can be extended to the palate, mandible, mouth angle, and temporomandibular joint region.

Egyedi first reported the successful application of a buccal fat pad (BFP) as a pedicled graft to the closure of persistent oroantral and oronasal defects in 4 patients after tumour resection. Since then, there have been several studies on the use of this flap for oral reconstruction, including that of the authors on the utility of pedicled BFP grafting in surgically induced defects following the resection of oral lesions in which they observed no severe contraction of soft tissues during postoperative follow-up ranging from 4 months to 5 years 11 months. BFP grafting is considered feasible for the repair of surgically induced defects in the maxilla, palate, and buccal mucosa. In Singh et al.’s review on the efficacy of BFP grafting, which covered 509 cases, most cases involved mainly BFP grafting for oroantral communication and cleft palate, and grafting to defects induced by ablative surgery, such as tumour excision, was relatively rare.

The authors have applied BFP grafting in cases of surgically induced defects, except those involving oroantral communication and cleft palate. The purpose of this study was to evaluate the applicability of pedicled BFP grafting for the reconstruction of surgically induced oral defects.

Materials and methods

BFP grafting was applied as a pedicled graft in the reconstruction of surgical defects in 23 patients (5 males, 18 females; mean age 68.3 years) between 2003 and 2011. Data on these cases was retrospectively collected and analyzed. Detailed clinical information for each case is shown in Table 1 .

Table 1
Clinical summary of the patients who underwent pedicled buccal fat pad (BFP) grafting.
No. Age Sex Location Pathological diagnosis Size of defect (mm) Size of BFP (mm) Follow-up term
1 26 F Palate Mucoepidermoid carcinoma 40 × 40 20 × 40 6 years 6 months
2 59 F Palate Pleomorphic adenoma 32 × 30 32 × 30 8 years 10 months
3 57 F Palate Pleomorphic adenoma 35 × 30 15 × 10 3 years 7 months
4 83 F Palate Myoepithelial carcinoma 40 × 20 40 × 20 1 year 2 months
5 73 F Palate Schwannoma 25 × 25 25 × 25 1 year 1 month
6 66 F Palate Pleomorphic adenoma Covering inner surface of facial flap 20 × 25 1 year
7 73 M Maxilla Ameloblastoma Covering inner surface of facial flap 43 × 38 3 years 6 months
8 87 F Maxilla Bisphosphonate-related osteonecrosis of the jaw 40 × 20 40 × 20 4 months
9 74 M Upper gingiva Squamous cell carcinoma Covering inner surface of facial flap 40 × 30 3 years 5 months
10 76 M Upper gingiva Squamous cell carcinoma 25 × 20 30 × 25 2 years 8 months
11 78 F Upper gingiva Leukoplakia 20 × 20 20 × 20 2 years 8 months
12 82 F Upper gingiva Squamous cell carcinoma 22 × 20 22 × 20 2 years 2 months
13 45 F Upper gingiva Squamous cell carcinoma 30 × 30 35 × 35 1 year 3 months
14 76 F Upper gingiva Squamous cell carcinoma 30 × 40 30 × 40 5 months
15 80 F Upper gingiva Lymphocytic proliferation 15 × 12 15 × 12 4 months
16 59 F Buccal mucosa Squamous cell carcinoma 27 × 22 27 × 22 5 years 6 months
17 78 F Buccal mucosa Squamous cell carcinoma 50 × 33 25 × 20 3 years 8 months
18 76 F Buccal mucosa Sialoadenitis of the minor salivary glands 25 × 20 25 × 20 3 years 8 months
19 69 F Buccal mucosa Squamous cell carcinoma 20 × 20 25 × 25 3 years
20 63 F Lower gingiva Squamous cell carcinoma 30 × 25 30 × 30 1 year 2 months
21 59 M Lower gingiva Squamous cell carcinoma 28 × 28 28 × 28 3 weeks
22 75 M Oral floor Ulcer 25 × 20 25 × 20 6 months
23 58 F TMJ Synovial chordromatosis 20 × 25 30 × 30 3 years 5 months

TMJ, temporomandibular joint.

The graft was used to cover the surgical defects of the palate ( n = 6), maxilla ( n = 2), upper gingiva ( n = 7), buccal mucosa ( n = 4), lower gingiva ( n = 2), oral floor ( n = 1), and temporomandibular joint (TMJ) region ( n = 1). A pedicled BFP was prepared by making a maxillary vestibular incision following the primary surgery. Extra attention was paid to preserving the surrounding connective tissue to supply nutrition to the pedicle during surgery. The grafts were placed on the raw surface of the soft tissue or bone surface and sutured to the surrounding tissue of the defect.

The condition of the BFP graft to the surgical defect, including epithelialization, graft infection, and fistula recurrence, was evaluated postoperatively. 1 year after surgery, facial contour deficiency was assessed from pre- and postoperative photographs, and functional recovery including limitation of opening mouth and facial nerve palsy was evaluated.

The study was conducted in compliance with the Declaration of Helsinki. Informed consent was provided by all participants.

Results

For defects of the palate, a BFP graft was used in 3 cases of pleomorphic adenoma and 1 case each of mucoepidermoid carcinoma, myoepithelial carcinoma, and schwannoma. These 6 patients (mean age 60.6 years) had defects ranging in size from 25 mm × 25 mm to 40 mm × 40 mm in the hard and soft palates. Five cases were complete defects penetrating to the nasal cavity, in which a skin substitute (TERUDERMIS ® , Olympus Terumo Biomaterials, Tokyo, Japan) accompanied the graft to cover the surgical defect, and the remaining case was a partial defect of the palate requiring use of the graft only.

Regarding defects of the maxilla and upper gingiva, BFP grafting was indicated in 9 patients (mean age 74.5 years): 5 cases of squamous cell carcinoma and 1 case each of lymphocytic proliferation, ameloblastoma, leukoplakia, and bisphosphonate-related osteonecrosis of the jaw (BRONJ). The size of the surgical defects ranged from 15 mm × 12 mm to 30 mm × 40 mm, while the size of the BFP graft ranged from 15 mm × 12 mm to 43 mm × 38 mm. Grafts were placed on the bone surface in all cases.

Regarding defects of the buccal mucosa, a pedicled BFP was prepared, placed, and sutured on the raw surface of the mucosa in 4 patients (mean age 70.5 years); 3 cases of squamous cell carcinoma and 1 of sialoadenitis. The surgical defects ranged in size from 20 mm × 20 mm to 50 mm × 33 mm.

Defects of the lower gingiva were reconstructed by BFP grafting in 2 cases (mean age 61 years) following resection of squamous cell carcinoma in the lower gingiva. The surgical defects ranged in size from 28 mm × 28 mm to 30 mm × 25 mm. The pedicled BFP was placed on the raw surface of the marginally resected mandible ( Fig. 1 ).

Jan 24, 2018 | Posted by in Oral and Maxillofacial Surgery | Comments Off on Applicability of buccal fat pad grafting for oral reconstruction
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