Harvesting the Buccal Fat Pad Does Not Result in Aesthetic Deformity in Cleft Patients: A Retrospective Analysis

Bennett, Katelyn G.; Thurston, Todd E.; Vercler, Christian J.; Kasten, Steven J.; Buchman, Steven R.

doi:10.1097/prs.0000000000003521

Cited by 31 publications

(26 citation statements)

References 36 publications

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“…The utilization of the BFPF to line large denuded lateral gaps at the gutters of the hard palate to decrease transverse width discrepancy, accelerate healing and increase durability of the repair without long-term residual aesthetic consequences has been previously described by our craniofacial team. 27,31,32 The use of the BFPF, however, as a surgical remedy to fill the void for a large interpositional dead space and to reinforce thin outer and inner lamellae in the anterior soft palate after posterior muscle transposition in wide and challenging cleft repairs has heretofore not been reported. There remains a subset of patients who present with very wide clefts and other challenging anatomic features such as thin and friable mucosal covers which are challenging to close.…”

Section: Discussionmentioning

confidence: 99%

“…31 Furthermore, multiple authors have demonstrated that use of the fat pad does not have long-term residual aesthetic consequences. 27,32 In this current study, the authors hypothesize that the resultant void that occurs once the levator sling has been retropositioned, particularly in wide and challenging cleft repairs, is responsible for tissue contracture that contributes to palatal shortening and relapse of the muscle position as evidenced as by poorer speech outcomes and increased fistula formation. Filling the void using the BFPF technique as a source of vascularized tissue functions to occupy the large interpositional dead space and reinforce thin outer and inner lamellae in the anterior soft palate after posterior muscle transposition.…”

Section: Introductionmentioning

confidence: 90%

“…31 Furthermore, multiple authors have demonstrated that use of the fat pad does not have long-term residual aesthetic consequences. 27,32…”

Section: Introductionmentioning

confidence: 99%

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Filling the Void: Use of the Interpositional Buccal Fat Pad to Decrease Palatal Contraction and Fistula Formation

Thurston

Vargo

Bennett

et al. 2020

FACE

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Objective: The objective of this study was to evaluate the ability of the buccal fat pad flap (BFPF) to fill the void remaining after muscle transposition and study its effect on durability, fistula rate, palatal shortening/contraction, and relapse of muscle positioning in wide and challenging cleft repairs. Design: A retrospective chart review was performed. Charts were abstracted for standard demographics, reason for BFPF utilization, palatal length, palatal fistula, co-morbidities, and speech outcomes. Patients, Participants: Patients under age 3 who underwent primary palatoplasty between October 2007 and September 2015 which utilized a medially placed BFPF were identified. Results: Fifty-three patients were identified. Mean age at palatoplasty was 1.4 (0.78-2.55) years. Mean follow-up was 2.52 (0.02-7.26) years. Twenty-four (45.3%) patients had concerning intraoperative findings warranting flap utilization. Twenty-nine (54.7%) patients underwent BFPF for large dead-space volume. Four patients (7.55%) experienced a fistula. Thirty-nine patients had comments on their palatal length. Of these, 28 (71.8%) were of average length, and 8 (20.5%) were long. Thirty-three patients have undergone formal speech evaluation. Of these, 20 (60.6%) were of normal resonance, and 12 (36.4%) demonstrated nominal hypernasality. No patients have yet to require a secondary speech operation. Conclusion: Use of the BFPF has become more common in our practice particularly in challenging cleft palate repairs. It is a versatile technique addressing large interpositional dead space and thin outer and inner lamellae in the anterior soft palate after posterior muscle transposition. Early results, in difficult repairs, demonstrate excellent durability and that palatal length appears to be maintained, potentially lessening the need for secondary speech surgery.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 90%

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Filling the Void: Use of the Interpositional Buccal Fat Pad to Decrease Palatal Contraction and Fistula Formation

Thurston

Vargo

Bennett

et al. 2020

FACE

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“…Isso provavelmente se deve ao uso restrito apenas da extensão bucal e corpo principal da bola de bichat, de modo que as demais extensões ainda proporcionam um arcabouço para a projeção da bochecha. Em adição, a literatura relata que a exérese do corpo adiposo (lipectomia) para finalidades estéticas possuem efeitos mínimos ou transitórios sobre a projeção da bochecha (Bennett, Thurston, Vercler, Kasten & Buchman, 2017).…”

Section: Discussionunclassified

Exérese da bola de bichat em infante: relato de caso

Andrade

Neto

Aguiar

et al. 2021

RSD

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Introdução: O corpo adiposo bucal é uma massa especializada composta por tecido adiposo. É uma estrutura profunda ao músculo bucinador, entretanto em crianças esse órgão pode extruir para a cavidade bucal, caracterizando uma entidade clínica chamada de herniação do corpo adiposo bucal. O presente estudo objetiva relatar um caso de paciente pediátrico com prolapso do coxim adiposo bucal após trauma. Relato de Caso: Participante do sexo masculino, 06 meses de idade, vítima de queda da própria altura, admitido no serviço de emergência de Cirurgia e Traumatologia Bucomaxilofacial de um hospital público, apresentando ferimento em cavidade oral. Não houve síncope e êmese após o trauma, sem patologias de base, uso crônico de medicamentos ou alergias. Não ocorreram sangramentos ou alterações de comportamento. Houve o prolapso do corpo adiposo bucal após 6 horas do trauma contuso. Ao exame físico apresentava contornos ósseos preservados em terço superior e médio de face, ausência de crepitação ou edema em ossos próprios nasais e ausência de ferimentos em face. Ao exame intra-oral, foi notada lesão de coloração amarelo-avermelhada, semelhante a gordura, inserida em mucosa jugal direita, de consistência macia. A terapêutica adotada foi a excisão do coxim adiposo sob anestesia local. Discussão: Após 18 meses do procedimento, participante se encontra sem assimetria e a mãe informou que não houve complicações na amamentação durante esse período. Conclusão: O presente caso corroborou com a literatura em seus aspectos clínicos, etiológicos e demográficos, sendo tratado através de terapêutica já sedimentada na literatura, demonstrando bom prognóstico.

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“…In these scenarios, the buccal fat pad flap can cover the raw surface and at least partially minimize the secondary healing process with fibrosis. [27,34] In the literature, different authors have described modified lateral relaxing incisions (e.g., only a small incision lateral to the hamulus) while others have reported palatoplasty without lateral relaxing incisions. [30,[35][36][37][38][39][40][41][42][43][44][45] Overall, the described benefits of these modified surgical approaches lies on the absence of exposed raw surface or healing by secondary intention, supposedly reducing perioperative contamination, bleeding, and pain and also minimizing postoperative scarring and bone growth interference.…”

Section: Discussionmentioning

confidence: 99%

Modified double-opposing Z-plasty for patients with Veau I cleft palate

et al. 2019

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Low fistula rate and a satisfactory speech outcome were previously reported by adopting a modified Furlow palatoplasty using small double-opposing Z-plasty (DOZ). The purposes of this study were to (1) describe the technical standardization of further modification of this small DOZ using the medial incision (MIDOZ) approach for Veau I cleft repair; (2) assess the early postoperative outcomes of a single surgeon's experience using this technique; and (3) evaluate the temporal association of this standardization with the necessity of lateral relaxing incisions.A prospective study (n = 24) was performed consecutively to non-syndromic patients with Veau I cleft palate who underwent MIDOZ approach. Patients with similar characteristics who underwent small DOZ were included as a retrospective group (n = 25) to control for the potential effect of the standardization of surgical maneuvers (including the hamulus fracture) on the rate of lateral relaxing incisions. Six-month complication rate was collected.No postoperative complications, such as bleeding, flap necrosis, dehiscence or fistula were observed. The prospective group had a significantly (all P < .05) higher rate of hamulus fractures (n = 48, 100%) and a lower rate of lateral relaxing incisions (n = 1, 2%) than the retrospective group (n = 16, 32%; n = 26, 52%).This technical standardization for performing palatoplasty using MIDOZ approach provided adequate Veau I cleft palate closure, without fistula formation, and with a low need of lateral relaxing incisions.

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Harvesting the Buccal Fat Pad Does Not Result in Aesthetic Deformity in Cleft Patients: A Retrospective Analysis

Abstract: Therapeutic, IV.

Cited by 31 publications

References 36 publications

Filling the Void: Use of the Interpositional Buccal Fat Pad to Decrease Palatal Contraction and Fistula Formation

Filling the Void: Use of the Interpositional Buccal Fat Pad to Decrease Palatal Contraction and Fistula Formation

Exérese da bola de bichat em infante: relato de caso

Modified double-opposing Z-plasty for patients with Veau I cleft palate

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