Buccal Fat Herniation
What is the Buccal Fat Pad?
The Buccal Fat Pad (Bichat’s Fat Pad) consists of a central body with 4 extensions:
1. Buccal
2. Pterygoid
3. Superficial Temporal &
4. Deep Temporal.
The Buccal extension locates superficially within the cheek, the Pterygoid and Temporal extensions are more deeply situated.
The Buccal extension is encapsulated by a parotidomasseteric fascia and enters the cheek below the parotid duct. It extends along the anterior border of the Masseter and descends into the Mandibular Retromolar region.
The Buccal Fat Pad had limited clinical importance for many years and was usually considered as a surgical hindrance because of its accidental encounter either during various surgeries in the pterygomaxillary space or injuries of the maxillofacial region.
It is currently of interest in aesthetic surgery, such as buccal lipectomy in the adults, to modify the contour of the face.
When the Buccal Fat Pad does herniate into the oral cavity, it is described as the traumatic herniation of buccal fat pad or a traumatic pseudo-lipoma.
Where is the Buccal Fat Pad?
How does it happen?
Injury to the Buccal Fat Pad is mostly the result of a deep incision performed during upper and lower 3rd molar surgery.
Any trauma can cause rupture of the Buccal Fat Pad Capsule causing the buccal extension to drop or prolapse into the mouth or subcutaneous layer.
Traumatic herniation of Buccal Fat Pad is most common with:
• surgery in the pterygomaxillary & mandibular regions
• any minor tear of the buccinator muscle can allow a herniation of buccal fat into the oral cavity
How is it repaired?
Treatment modality for the traumatic herniation of the Buccal Fat Pad includes:
• Repositioning of the Buccal Fat Pad followed by primary closure, when the case is reported immediately within first 5 hours with small protruded mass with minimal inflammatory changes.
• When the case is reported after 4 hours, or the Buccal Fat Pad is too large to replace in the limited laceration injury site or necrosis has developed, it is recommended to excise the mass at the base without traumatising adjacent parotid papilla & duct.