The buccal fat pad and its morphological and clinical aspects in Dentistry

Abstract

Introduction: The buccal adipose tissue (BFB) is a structure of adipose tissue surrounded by a thin capsule of dense connective tissue located between the buccinator muscle and the skin of the cheek. This was first described in 1802 by the anatomist Marie François Xavier Bichat and, since then, has been referred to as “Bichat ball”. In dentistry, there are some clinical applications to this structure, from its use to fill gingival grafts or treatment of oroantral communication to its surgical removal, in orofacial harmonization. Thus, knowledge of its morphology and clinical approach is essential for the dental surgeon.
Objective: The objective of this observational work is to describe the morphological aspects of the Bochecha Adipose Body and its clinical-surgical applications in dentistry, through a literature review.
Methodology: The scientific articles were collected from online databases, with no date restriction, and selected based on the topic of interest in this study, applying the keywords adipose body of the cheek, morphology and dentistry. The genial region was dissected in an unidentified anatomical piece from the study collection of the Laboratory of Human Anatomy of the Federal University of Uberlândia (UFU).
Results and Discussion: The CAB has a complex anatomy with an encapsulated central part and similar size in different individuals with a mean weight of 9.3 grams and volume of 9.6 milliliters (Stuzin et al., 1990). Therefore, it is different from the subcutaneous tissue, but it has extensions to some facial, oral, pterygoid, and deep and superficial temporal spaces. It has a local thermogenic function and protection of vessels and nerves, especially in the genial region (Racz et al., 1989). In orofacial harmonization, the surgical removal of its central part can be performed, reducing the aesthetic volume of the genial region and emphasizing the malar prominence, sculpting the facial angles (Ramirez, 1999), a procedure known as bichectomy. However, considering the functions of the CAB, there is a need for studies on the long-term effects of bichectomy in the elderly, since during the aging of the face there is a deepening of the frontal area of the maxilla, alteration in the margins of the orbital cavity and the lateral narrowing of the base of the mandible (Mendelson; Wong, 2012), giving the face a cadaverous appearance. It can also be used as a structure for gingival grafting, closure of bucosinusal communication, reconstruction of ankylosed temporomandibular joint or lip filling material or in orbital reconstruction.
Conclusion: For dentists and professionals who work in the head and neck region and in cosmetic surgeries on the face, it is essential to know the complex anatomy and morphology of the buccal fat pad and adjacent structures, considering the topographic anatomy and local stratigraphy. Thus, the theoretical basis combined with scientific and clinical information becomes a clinical tool to facilitate the clinical approach of the patient and the surgical practice of this facial structure, providing a better treatment plan necessary and adequate for each case, as well as surgical interventions. . However, we warn in this work that there are no studies in the world literature on the long-term aesthetic and mainly functional effects of bichectomy. Gingival filling procedures and bucosinusal communication closure can present satisfactory results.