Buccal fat pad flap - Vula - University of Cape Town

extends up to the inferior orbital fissureand surrounds the temporalis muscle, andextends down to the superior rim of themandibular body, and back to the anteriorrim of the temporalis tendon and ramus. Indoing so it forms the buccal, pterygopalatineand temporal processes.Four processes (buccal, pterygoid, superficialand deep temporal) extend from thebody into surrounding spaces such as thepterygomandibular and infratemporal fossae.IndicationsReconstruction of small to medium(

Surgical StepsSurgery may be done under local orgeneral anaesthesiaThree approaches (Figure 6)o Incise buccal mucosal membrane1cm below the opening of parotidduct (Matarasso’s method)o Incise behind the opening of parotidduct (Stuzin’s method)o Incise superior gingivobuccal sulcusFigure 7: Careful delivery of fat pad afterincising the capsulePosition the buccal fat pad flap indefect and secure it with absorbablesutures (Figures 8, 9)Cover the flap with mucosa if feasible(Figure 9)Figure 6: Position of fat pad relative toparotid ductCut through the buccinator muscle withdiathermy and dissect bluntly until thebuccal fat pad is foundIncise the thin capsule of the buccal fatpadGently deliver the required volume ofbuccal fat tissue into oral cavity bygentle to-and-fro traction on the buccalfat, so as not to disrupt the bloodsupply and hence devascularise the flap(Figure 7)Take care not to injure the inferiorbuccinator branches of facial artery soas to avoid causing a haematomaFreshen the edges of the recipient siteFigure 8: Flap placed over an oronasaldefectFigure 9: Flap sutured to defect, andpedicle covered with mucosa3

Await epithelialisation of the flapwhich usually occurs within 1 month(Figure 10)Figure 11: Defect filled with buccal fadpadSummaryFigure 10: Mucosalised flap approximatelya month postoperativelyComplicationsComplications rarely occur and mayinclude partial necrosis and excessivescarring. With large flaps used for buccaldefects there is a risk of fibrosis andtrismus.Clinical exampleThe buccal fat pad is a simple, reliable flapfor repair of small-to-medium sized oraldefects. It has an excellent blood supplyand causes minimal donor site morbidity.Author & EditorJohan Fagan MBChB, FCORL, MMedProfessor and ChairmanDivision of OtolaryngologyUniversity of Cape TownCape TownSouth Africajohannes.fagan@uct.ac.zaTHE OPEN ACCESS ATLAS OFOTOLARYNGOLOGY, HEAD &NECK OPERATIVE SURGERYwww.entdev.uct.ac.zaFigure 10: Buccal fat pad adjacent tointeralveolar defectThe Open Access Atlas of Otolaryngology, Head &Neck Operative Surgery by Johan Fagan (Editor)johannes.fagan@uct.ac.za is licensed under a CreativeCommons Attribution - Non-Commercial 3.0 UnportedLicense4