The Bichat’s Fat Pad: A Multifunctional Resource in Oral, Maxillofacial, and Facial Aesthetic Surgery

ABSTRACT

The Bichat’s Fat Pad (BdB), or buccal fat pad, is a highly vascularized tissue source, adaptable to various small- and medium-sized tissue defects, and is easily accessible surgically.

Anatomical description and function: the BdB consists of a main body and 4 extensions. The main body is located immediately above the periosteum in relation to the maxillary tuberosity on its postero-vestibular side and just anterior to the masseter muscle. The four extensions extend in the buccal/inferior, masseteric/superficial, pterygoid/posterior, temporal/deep, and cranial/superior directions. The BdB facilitates the gliding of muscles, tendons, nerves, and the mandible during facial expression and mastication movements.

Surgical indications: these are numerous and range from the closure of oroantral fistulas and perforations of the antral mucosa, to the obliteration of tissue defects during oncologic surgery, to the enhancement of the zygomatic contour in aesthetic surgery, and the doubling of the thickness of mucosal flaps covering bone grafts. When used as a graft, the BdB serves as a source of adipose tissue for covering myomucosal defects in the oral cavity and for filling aesthetic defects.

Surgical technique: the procedure is explained in detail through videos and photographs, showing how to expose, define, and manage the preparation of the BdB as a flap or graft, with particular attention to vascular safety, the branches of the facial nerve, and Stensen’s duct.

Presentation of clinical cases: typical applications in oral, maxillofacial, and aesthetic surgery are illustrated.

Discussion: ample time is allotted for participants’ questions and answers.