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 .
| 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 |
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 ).
