Februari 07, 2017
the buccal fat pad flap is an axial flap andmay be used to fill small-to-medium sizedsoft tissue and bony defects in the palate,superior and inferior alveoli and buccalmucosa. prof dr. mounzer assed indications reconstruction of small to medium (<5cm) congenital or acquired soft tissue and bony defects in the oral cavi-ty. this includes oronasal and oroan-tral communications following dental extraction; surgical defects following tumour excision, excision of leukopla-kia and submucous fibrosis; and prima-ry and secondary palatal clefts the buccal fat pad is an encapsulated, mass of specialized fatty tissue, the volume of which varies throughout life it fills the deep tissue spaces and acts as gliding padswhen masticatory and mimetic muscles contract, and cushions important structures from forces generated by musclecontraction. cut through the buccinator muscle with diathermy and dissect bluntly until the buccal fat pad is found incise the thin capsule of the buccal fat pad
four processes (buccal, pterygoid, super-ficial and deep temporal) extend from the body into surrounding spaces such as the pterygomandibular and infratemporal fossae. the buccal fat pad has a body and fourprocesses. the body is located behind thezygomatic arch. the body is divided into 3lobes – anterior, intermediate andposterior, in accordance with the structure of the lobar envelopes, the ligaments and the feeding vessels the parotid duct passes along the lateralsurface or penetrates the body of the fatpad before traversing the buccinatormuscle and entering the oral cavity three approaches incise buccal mucosal membrane 1cm below the opening of parotid duct (matarasso’s method) incise behind the opening of parotid duct (stuzin’s method) incise superior gingivobuccal sulcus gently deliver the required volume of buccal fat tissue into oral cavity by gentle to-and-fro traction on the buccal fat, so as not to disrupt the blood supply and hence devascularise the flap
take care not to injure the inferior buccinator branches of facial artery so as to avoid causing a haematoma freshen the edges of the recipient site position the buccal fat pad flap in defect and secure it with absorbable sutures cover the flap with mucosa if feasible await epithelialisation of the flap which usually occurs within 1 month the buccal fat pad flap is an axial flap. the facial, transverse facial and internal maxillary arteries and their anastomosing branches enter the fat to form a sub-capsular vascular plexus the buccal fat pad can be rotated to cover a variety of defects coverage of exposed maxillary and mandibular bone or bone grafts and bone flaps
alternative or backup for failed buccal advancement flaps, palatal rotation and transposition flaps, tongue and naso-labial flaps, and radial free forearm flaps.
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