Postoperative Evaluation of the Intraoral Technique of Buccal Fat Pad Removal
Condition: Bichat's Fat Pad Atrophy; Facial Expression
MeSH terms: Atrophy
Study type: Interventional

Summary: 
      In recent years there has been a growing number of procedures for the removal of the buccal
      fat pad (BFP) or as frequently referred to as bichectomy. Buccal fat pad removal can be used
      as part of the therapeutic procedure in cases of: sinus buco fistulas, peri-orbital defects,
      congenital palatal fissure, patients with severe bruxism, patients with constant lesions
      caused by bites on the jugal mucosa and in patients who are dissatisfied with the facial
      contour. In cases of thinning of the face, biting lesions and bruxism, total or partial of
      the BFP removal is performed, always taking into account a facial harmonization. The aim of
      the present study was to demonstrate the procedure of BFP removal and its respective
      postoperative period. A total of 40 BFP removal surgeries were performed between 2016 and
      2017 with intraoral access technique. After the bichectomy procedure the subjects were
      followed for: 4, 7, 10, 15, 30, and 90 days. The postoperative period can be compared to that
      of a third molar extraction, and the use of analgesics and anti-inflammatories can adequately
      control the pain symptomatology. Edema and mouth opening limited for about 15 days were the
      most commonly found alterations in surgeries performed. The surgical technique is a simple
      and safe procedure provided by trained and experienced professionals. The bichectomy should
      be performed following a precise indication and the procedure is becoming a new area of
      practice for the dental surgeon, who can perform the procedure safely, reliably and with
      aesthetic and therapeutic results provided that with precise indications.
    

Detailed description: 
      The investigators included in the present study 40 patients who sought the UNIMES Dentistry
      Clinic for the BFP removal procedure. All female, aged between 20 and 40 years and showing
      good general health. All the patients received information and had access to the informed
      consent form that after the necessary explanations was duly filled and signed. Clinical
      parameters such as periodontal indices (depth of probing, plaque index and gingival index),
      characteristics of the jugal mucosa, opening of the mouth, and the amount of fat removed were
      evaluated. After detailed anamnesis and verified the need to remove the buccal fat pad by
      constant bite on the jugal mucosa or for aesthetic reasons of facial thinning the patients
      were instructed to perform the blood tests, fasting blood glucose and complete blood count.
      With the exams presenting normal levels and compatible with health status, the patients were
      scheduled to perform the proposed therapy. The surgical procedure was performed using the
      technique with intrabuccal access, already consecrated in the literature (Materasso, 2006).
      The buccal fat pad access was made by means of a small incision no more than 3 mm in length
      in the soft tissue located in the lower aspect of the zygomatic counterfoot, taking care to
      visualize and protect with the retractor the Stensen's conduit. With the aid of blunt-tipped
      or hemostatic scissors dissection was performed, taking care to preserve the membrane
      surrounding the ball of fat. After removal of one side, pressure was removed to remove air
      and the procedure was started on the opposite side, after the removal of the two sides was
      realized simple suture with silk thread. There were no formal indications for sending the
      samples for anatomic and / or histological examination. Patients were adequately medicated
      with analgesics and anti-inflammatories and antibiotics for 5 days. Kinesio therapy tapes
      were applied and placed towards the origin for insertion of the muscles involved in the
      region, and exchanged after 4, 7, and 10 days. Severe bilateral cryotherapy in the areas of
      extraoral surgery for 24 to 48 hours was performed. The first return was 4 days after the
      procedure and the next 7, 10, 15, 30, and ninety days, where physical, clinical, standardized
      photos and oral opening measurements were performed.
    

Intervention name(s): BFP removal
Intervention type(s): Procedure
Intervention description(s): The surgical procedure was performed using the technique with intrabuccal access, already consecrated in the literature (Materasso 2006). The Bichat fat ball access was made by means of a small incision no more than 3 mm in length in the soft tissue located in the lower aspect of the zygomatic counterfoot, taking care to visualize and protect with the retractor the Stensen's conduit. With the aid of blunt-tipped or hemostatic scissors dissection was performed, taking care to preserve the membrane surrounding the ball of fat. After removal of one side, pressure was removed to remove air and the procedure was started on the opposite side, after the removal of the two sides was realized simple suture with silk thread. There were no formal indications for sending the samples for anatomic and / or histological examination.
Intervention model: Single Group Assignment
Intervention model description: We included in the present study 40 patients who sought the UNIMES Dentistry Clinic for the BFP removal procedure. All female, aged between 20 and 40 years and showing good general health. All the patients received information and had access to the informed consent form that after the necessary explanations was duly filled and signed.
Clinical parameters such as periodontal indices (depth of probing, plaque index and gingival index), characteristics of the jugal mucosa, opening of the mouth, and the amount of fat removed were evaluated. After detailed anamnesis and verified the need to remove the fat ball by constant bite on the jugal mucosa or for aesthetic reasons of facial thinning the patients were instructed to perform the blood tests, fasting blood glucose and complete blood count. With the exams presenting normal levels and compatible with health status, the patients were scheduled to perform the proposed therapy.
Masking: None (Open Label)
Primary purpose: Treatment
Keywords: Buccal mucosa