Kim et al.

Maxillofacial Plastic and Reconstructive Surgery (2017) 39:5

DOI 10.1186/s40902-017-0105-5
Maxillofacial Plastic and
Reconstructive Surgery

REVIEW Open Access

The use of the buccal fat pad flap for oral

reconstruction
Min-Keun Kim1, Wonil Han2 and Seong-Gon Kim1*

Abstract
Many congenital and acquired defects occur in the maxillofacial area. The buccal fat pad flap (BFP) is a simple and
reliable flap for the treatment of many of these defects because of its rich blood supply and location, which is close
to the location of various intraoral defects. In this article, we have reviewed BFP and the associated anatomical
background, surgical techniques, and clinical applications. The surgical procedure is simple and has shown a high
success rate in various clinical applications (approximately 90%), including the closure of oroantral fistula, correction
of congenital defect, treatment of jaw bone necrosis, and reconstruction of tumor defects. The control of etiologic
factors, size of defect, anatomical location of defect, and general condition of patient could influence the prognosis
after grafting. In conclusion, BFP is a reliable flap that can be applied to various clinical situations.
Keywords: Buccal fat pad flap, Defect, Reconstruction, Oral, Wound epithelialization

Introduction case, the soft tissue defect with problems in wound

Soft tissue coverage is an essential step for successful healing is a common feature.
wound healing. Intraoral wounds have certain unique Vascularized grafts may be considered as first choice
features compared to other wound sites. The soft tissue of treatment in oral reconstruction, but have limitations.
overlying the alveolar bone is relatively thin, and there is Patients with compromised wounds usually have poorly
no fatty layer in the gingiva. Therefore, vascularized skin vascularized tissue, and patients with severe diabetes
graft is too bulky in most cases, and the color of skin mellitus have difficulties with capillary regeneration [10].
graft is not matched to that of the oral mucosa [1]. Free These patients have demonstrated higher rates of post-
mucosal graft from the palate has a well-matched color operative infection and graft failure [10]. Patients receiving
and similar thickness to the gingiva [2]. However, the radiation therapy or chemotherapy also experience prob-
size of the palatal mucosa is limited. As the palatal mu- lems in wound healing [11]. Moreover, patients receiving
cosal graft is a free graft, it is not indicated for poorly high doses of bisphosphonate often show avascular jaw
vascularized recipient beds [2]. bone necrosis following oral surgery [9]. Although revision
Intraoral soft tissue defect can be induced by various surgery is attempted for these patients, vascularized grafts
diseases or complications. Cleft palate and cleft alveolus are the only conventional method that have not failed
are congenital defects that accompany bone defects [3, 4]. [12]. However, vascularized grafts should be performed
Oroantral fistula is often observed after tooth extraction under general anesthesia and require a long operation
in cases of severe sinus pneumatization [5, 6]. Tumor or time. Donor site morbidity and an additional scar are the
trauma also shows various degrees of soft tissue defect disadvantages of using vascularized grafts [12].
[7, 8]. Recently, many cases of medication-induced Buccal fat pad flap (BFP) has been used for the recon-
osteonecrosis of the jaw have been reported, and these struction of maxillary defects induced by tumor since it
patients have denuded bone surface [9]. Although the was first reported in 1977 [13]. From then, many clinical
size, location, and etiology are different from case to applications of BFP have been introduced. The buccal fat
pad appears 3 months in utero and continuously grows
* Correspondence: [email protected] until birth [14]. There is little change in the volume of
1
Department of Oral and Maxillofacial Surgery, College of Dentistry,
Gangneung-Wonju National University, 7 Jukhyun-gil, Gangneung 25457, buccal fat during aging, and it is approximately 10 mL [14].
Republic of Korea Therefore, it is a reliable flap for the reconstruction of oral
Full list of author information is available at the end of the article

© The Author(s). 2017 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0
International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and
reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to
the Creative Commons license, and indicate if changes were made.
Kim et al. Maxillofacial Plastic and Reconstructive Surgery (2017) 39:5 Page 2 of 9

defects. Most published studies have reported a high suc- When properly dissected, the buccal fat pad provides a 6 ×
cess rate among BFP procedures due to BFP’s rich vascular- 5 × 3-cm graft. The average thickness is 6 mm, and this can
ity, proximity to the recipient site, low donor-site cover an area of 10 cm2 [16, 17].
morbidity, and simple surgical procedure for grafting [15]. The buccal fat pad has abundant blood supplies from the
This review discusses the anatomical background and sur- maxillary artery and the superficial and deep temporal ar-
gical technique of BFP. In addition, the clinical application tery. There are rich capillary networks within the capsules
of BFP and its results are discussed. that cover the fat pad. Arterioles enter the capsule from sev-
eral directions and break up into capillary plexuses. Most of
the blood from the fat pad drains into the facial vein [16].
Review Stensen’s duct is an adjacent anatomic structure, so it is eas-
Anatomical background and surgical technique ily encountered when extracting the buccal fat pad. Thus,
Anatomic background surgeons should take care not to damage this apparatus.
The buccal fat pad appears at 3 months in utero and
continuously grows until birth [14]. It protrudes at the Surgical technique
anterior border of the masseter muscle and extends to After lidocaine (1%) with 1:100,000 epinephrine is infil-
the parotid duct, where it rests on the buccopharyngeal trated, Stensen’s duct should be identified with a lacri-
fascia, which covers the buccinator muscle [16]. There is mal probe before incision to avoid damaging it during
little change in the volume of buccal fat during aging, the procedure. A 2–3-cm mucosal incision was made at
and it is approximately 10 mL [14]. least 2 cm below the Stensen’s duct. Two or three tagging
The buccal fat pad is composed of lobes and highly mo- sutures were placed at the margin of the mucoperiosteal
bile structures (Fig. 1). It has a main body and four exten- flap to gain appropriate surgical fields. The buccinator and
sions: temporal, buccal, pterygoid, and pterygopalatine [15]. zygomaticus major muscles were cut, and blunt dissection
The main body is surrounded by the buccinator muscle, was carefully performed to create sufficient openings for
masseter muscle, and zygomatic arch. The main body is herniating the fat pad without injuring the capsule
positioned along the posterior maxilla and covered with a overlying the fat pad. After the superficial fascia of the
thin capsule. The parotid duct pierces the buccinator at the face was cut, the fat pad herniated spontaneously
anterior border of the buccal fat pad [16]. The average vol- (Fig. 2). The capsules overlying the fat pad should not
ume of the fat pad is 9.6 mL (range, 8.3–11.9 mL). The be torn so as to maintain its volume, and the arterioles
average weight of the fat pad is 9.3 g (range, 8–11.5 g). and venules overlying the fat pad should be preserved

Fig. 1 Anatomical location of the buccal fat pad. The buccal fat pad is composed of a main body and four extensions (temporal, buccal, pterygoid,
and pterygopalatine)
Kim et al. Maxillofacial Plastic and Reconstructive Surgery (2017) 39:5 Page 3 of 9

Fig. 2 Surgical procedure for the buccal fat pad flap. A blunt dissection is carefully performed without injuring the capsule overlying the fat pad.
After the superficial fascia of the face was cut, the fat pad herniated spontaneously

to maintain the rich blood supply. Tissue forceps were because food and fluid regurgitate into the maxillary
used for the traction of the fat pad with minimal force sinus and may result in sinusitis [20, 21]. The traditional
to avoid tearing the capsule. Pedicled buccal fat pad methods for treating oroantral fistula have been buccal
was sutured and positioned using absorbable suture advancement flap or rotational palatal flap. Vestibular
materials with minimal tension. Making the incision at shallowing is a drawback of the buccal advancement flap
the bone is a good technique for maintaining the position [18]. Moreover, patients with damaged gingiva or those
of the fat pad. who received a previous closure operation cannot be
indicated for the buccal advancement flap [18]. How-
Clinical application ever, BFP demonstrated high success rates, even in pre-
Oroantral fistula associated with tooth extraction or dental viously operated cases [19]. The surgical procedure of
implant removal BFP graft for the treatment of oroantral fistula is very
Oroantral fistula is the state of patent communication simple (Fig. 3).
between the oral cavity and the maxillary sinus [5, 18]. Studies involving less than five patients were excluded
Although it is common after a tooth or dental implant from the present review. In the literature, all studies
extraction, patent opening to the maxillary sinus can cited tooth or dental implant removal as an etiology of
also be induced by a pathological condition such as oroantral fistula. BFP was the only treatment used in
osteonecrosis, cyst, or tumor, or by congenital deformity most studies. In one study, two patients received collagen
such as cleft palate. As the extent of bony defect is gen- strip as an additional therapy [20]. Overall, 12 papers and
erally larger in pathological conditions and congenital a total of 319 patients were included in this review
deformities than in cases requiring a simple extraction, (Table 1). Reperforation after sealing the oroantral fistula
pathological conditions related to oroantral communica- was reported in 12 patients, and the overall success rate
tions are discussed separately. was 96.2%. The reperforation of oroantral fistula can be
Oroantral fistula associated with extraction is mainly caused by the remaining infected tissue in the fistula area
observed in the maxillary premolar or molar area [5]. [21]. Complete removal of inflammatory tissue is an es-
Patients with severe sinus pneumatization are vulnerable sential step for a successful operation [18]. As the vascular
to oroantral fistula after extraction [18, 19]. Root frac- pedicle of the BFP is fragile, careless handling of the tissue
ture and subsequent improper instrumentation is also a can damage the vascular supply of the flap [18]. Other
cause of oroantral fistula. Oroantral fistula can appear causes of failure include surgery by an inexperienced sur-
immediately after the removal of a tooth or dental im- geon and invasive surgery [22].
plant and remain unhealed for over 1 month [5]. Small- Although BFP showed high success rates in sealing
sized perforations (≤2 mm) can be allowed to heal spon- oroantral fistula, it could not increase bone regener-
taneously. Persistent communications should be treated ation [23]. Therefore, dental implant installation into
Kim et al. Maxillofacial Plastic and Reconstructive Surgery (2017) 39:5 Page 4 of 9

Fig. 3 Closure of oroantral fistula by the buccal fat pad flap

the reconstructed defect by BFP is not recommended. The success rate of cleft palate surgery is influenced
For bone regeneration, BFP should be used with proper by many factors. The main flap for the cleft palate sur-
bone graft materials. gery is fed by the greater palatine artery and the lesser
palatine artery [24]. If the palatal defect is wide, the flap
width will be narrowed. These long narrow flaps may
Congenital defect cause problems with blood circulation, and wide expanses
Cleft palate is a common congenital deformity [24, 25]. of exposed raw bone surface can cause extensive wound
It is caused by incomplete fusion of the maxillary contracture after the operation [24–26]. Ischemic damage
process during the developmental stage. Although many and wound contracture is the main cause of postoperative
etiologic factors such as genetics and the environment palatal fistula. The incidence of postoperative palatal fis-
have been suggested, the pathogenesis of cleft palate re- tula is reported to be 4.6–12.5% and is dependent on the
mains controversial [3, 4]. For the treatment of cleft pal- degree of the tissue defect [27]. Wound contracture after
ate, sealing the communication between the oral cavity operation can cause shortening of the soft palate and may
and the nasal cavity is essential for successful treatment result in velopharyngeal insufficiency [28].
[25, 26]. Many types of flap design have been introduced The BFP has abundant vascular supply. The operation
for the treatment of cleft palate. field for the flap generation is also adjacent to the oper-
ation field of cleft palate surgery (Fig. 4). Most cleft pal-
Table 1 Oroantral fistula treated by BFP ate patients are children, and the BFP is particularly well
Number of patients Average age (range) Re-perforation Ref developed in children. BFP can be placed on the junction
25 45 (35–56) 0 [5] between the hard palate and soft palate to prevent pos-
24 NA 0 [6] sible palatal fistula (Fig. 4a) [24, 25], or it can be used
130 39 (15–90) 9 [18]
for covering the raw bone surface after sealing the palatal
flap (Fig. 4b) [26]. BFP is particularly useful for the repair
15 37 (22–57) 1 [19]
of secondary defect after cleft palate surgery [3, 4].
7 33 (NA) 0 [20] Few publications, other than case or technical reports,
14 38 (21–56) 1 [21] have discussed BFP’s usefulness for cleft palate surgery.
10 38 (NA) 0 [22] Studies with less than five patients were excluded, and
9 51 (29–64) 1 [61] six papers encompassing a total of 101 patients were in-
cluded (Table 2). Two of the included papers had some
56 NA (19–56) 0 [62]
common data [3, 4]; therefore, the actual number of
12 40 (NA) 0 [63]
patients may be overestimated. Only a single case of
11 43 (24–62) 0 [64] postoperative fistula was reported, and it was spontan-
6 44 (32–51) 0 [65] eously healed without further treatment [3]. A max-
NA not available, Ref reference number imum of a 20 × 10-mm palatal defect could be covered
Kim et al. Maxillofacial Plastic and Reconstructive Surgery (2017) 39:5 Page 5 of 9

Fig. 4 The application of the buccal fat pad flap (BFP) for the treatment of cleft palate. a BFP can be placed on the junction between the hard
palate and soft palate to prevent possible palatal fistula. b BFP can be used for covering the raw bone surface after sealing the palatal flap

with BFP [3, 4]. Tongue flap or temporal fascia flap has Osteonecrosis of the jaw bone
been used to repair secondary palatal defects. However, Osteonecrosis can result from radiation therapy during
both techniques require extensive operation time and the treatment of malignancy [30] or medications, such
have moderate donor site morbidity. Considering the as bisphosphonate and denosumab [9]. The main mechan-
ease of this technique and availability of BFP, it can be ism of osteonecrosis is vascular impairment and resultant
considered for the secondary repair of palatal fistula lo- hypoxia. Additional microbial invasion and dental proce-
cated at the posterior palate [3, 4]. However, with the dures are subsequent events that lead to the progression
current BFP technique, it is difficult to cover defects of osteonecrosis [31]. Nonsurgical therapy for osteonecro-
located at the anterior palate [4]. sis consists of regular dressing and prescription of supple-
BFP may be used for the prevention of palatal fistula mental antibiotics. Because of the avascular nature of the
during palatoplasty [29]. It has been claimed that there disease, hyperbaric oxygen therapy has also been used in
is no impairment in function and growth of the palate some studies [32]. Surgical intervention involves the
covered with BFP compared to the use of conventional complete removal of necrotic bone and subsequent recon-
techniques [29]. However, there has been no compara- struction with rich vascularized tissue [30]. Microvascular
tive study in the function and growth of the palate after reconstruction has been used for the reconstruction of
pedicled buccal fat pad application. Comparative analysis osteonecrosis because of poorly vascularized tissue beds in
with conventional technique should be performed to val- recipient sites [33].
idate the BFP as a preventive measure for cleft palate After excluding the papers with a small sample size
surgery. (≤5), only three papers discussing osteonecrosis of the
jaw bone were included in this review (Table 3). The
total number of patients was 43, and 38 patients showed
Table 2 Cleft lip and alveolus treated by BFP uneventful healing (88.4%). Two cases of 100% unevent-
Number of Average age Primary/ Post-operative Ref ful healing were reported, in which patients showed
patients (range) secondary fistula bone exposure during follow-up after restarting medica-
29 NA (2.5–19) Secondary 1 [3] tion [9]. Unsuccessful epithelial healing on the bone is
20 8.9 (2.5–19) Secondary 0 [4] frequently observed in cases with incomplete resection
6 7.2 (2–30) NA 0 [65] of the necrotic bone [30, 34]. These cases could be
8 28 (19–46 Primary 0 [24] treated by additional resection of sequestrum [30, 34].
months) Some cases of osteonecrosis are poorly responsive to
14 3.2 (11–15 Mixed 0 [25] conservative therapy [30, 34]. For example, the success
months) rate of conservative therapy for osteoradionecrosis has
24 4.7 (6–17 Mixed 0 [29] been reported to be 37–44% [35, 36]. Patients who cannot
months) be treated by conservative therapy should receive surgical
NA not available, Ref reference number intervention. The location and size of the osteonecrosis
Kim et al. Maxillofacial Plastic and Reconstructive Surgery (2017) 39:5 Page 6 of 9

Table 3 Osteonecrosis treated by BFP

Number of patients Average age (range) Cause Location Uneventful healing Ref
23 68 (39–93) Medication Mx: 23 23 [9]
10 56 (24–74) Radiation Mx: 2, Mn: 8 6 [30]
10 73 (57–81) Medication Mx: 2, Mn: 8 9 [34]
Mx maxilla, Mn mandible, Ref reference number

are sometimes an obstacle for reconstruction with BFP were induced by malignant tumor, and 102 were induced
[30]. Lower reconstructive success rates have been found by benign tumors. The anatomic location of the defect
with advanced stages of osteoradionecrosis compared to was mainly the maxilla (n = 141). Posterior mandible or
early stages [30]. A microvascular free flap can be used for buccal mucosal defects can also be restored by BFP, but a
advanced stages of osteoradionecrosis [33]. tumor-free resection margin is essential for successful
treatment [40].
Cyst or tumor If there is a sound oral epithelium, BFP can be used for
BFP has been frequently used in the successful recon- the coverage of autogenous free block bone graft [41, 42]
struction of intraoral defects, including those induced by or titanium mesh with particulate bone [8] on the op-
benign tumors and cysts (Fig. 5). The first clinical appli- posite side of the sinus. As the maxillary sinus mucosa
cation of BFP was for the closure of a defect in the palate is thin and frequently removed during tumor surgery,
induced by a tumor [13]. In Egyedi’s report [13], a split- well-vascularized BFP can be substituted for sinus mu-
thickness skin graft was applied on the BFP. Later, cosa to cover a bone graft [42]. When the BFP is used
Tideman et al. [37] reported that epithelialization could as a barrier for free bone graft, the incidence of infec-
be observed on the BFP without skin graft. The regen- tion and graft resorption may be reduced [41].
erated epithelium is parakeratinized stratified squamous When using BFP to treat defects induced by a malig-
epithelium and looks similar to the adjacent oral epi- nant tumor, postoperative radiation therapy should be
thelium [38]. In cases of moderate-sized palatal defects, considered. Any supplementary cancer therapy can in-
BFP allows early epithelialization without postoperative duce bone exposure and fistula [38, 40]. As BFP can be
discomfort [39]. used for the repair of bone necrosis defect, it should be
Twelve papers were included in this review after exclud- spared for future use in malignant tumor patients [30].
ing the papers with a small sample size (≤5) (Table 4). The For the reconstruction of tumor defects, excessive fat is
total number of patients was 202, and 180 patients required at times, and the patient may show limitation
showed uneventful healing (89.1%). Eighty-six defects of mouth opening [43]. As the function of the buccal fat

Fig. 5 The application of the buccal fat pad flap (BFP) after tumor resection. BFP can be used with free bone graft for the reconstruction of the
maxillary sinus wall
Kim et al. Maxillofacial Plastic and Reconstructive Surgery (2017) 39:5 Page 7 of 9

Table 4 Cyst or tumor treated by BFP

Number of patients Average age (range) Cause Location Uneventful healing Complication Ref
22 67.5 (26–83) Mal: 12, Be: 10 Mx: 14, Mn: 2, B: 4, FOM: 1, TMJ: 1 22 0 [7]
15 27.9 (17–50) Be: 15 Mx: 15 13 Inf: 2 [8]
11 34.4 (15–60) Be: 5, C: 6 Mx: 11 8 GL:2, Bl: 1 [19]
11 57.6 (42–70) Mal: 7, Be: 4 Mx: 10, B: 1 11 0 [65]
12 60.6 (32–90) Mal: 10, Be: 1, C: 1 Mx: 4, Mn: 7, B: 1 11 Inf: 1 [37]
28 52 (9–85) Mal: 19, Be: 8, C: 1 Mx: 22, Mn: 2, B: 1, Mix: 3 28 0 [38]
6 54.7 (41–69) Mal: 3, Be: 3 Mx: 6 5 GL: 1 [39]
15 57.9 (34–78) Mal: 10, Be: 5 Mx: 5, Mn: 3, B: 7 8 MOL: 7 [43]
15 NA Mal: 15 Mx: 6, Mn: 3, B: 6 13 GL: 2 [45]
38 26 (14–54) Be: 36, C: 2 Mx: 38 35 Fistula: 3 [41]
21 NA (28–72) Mal: 10, Be: 11 Mx: 2, Mn: 2, B: 16, Mix: 1 20 Tumor invasion: 1 [40]
8 36.6 (20–68) Be: 4, C: 4 Mx: 8 6 Fistula: 1, Deh: 1 [42]
Ref reference number, Mal malignancy, Be benign, C cyst, Mx maxilla, Mn mandible, B buccal mucosa, MOL mouth opening limitation, NA not available, GL loss of
graft, Inf infection, Bl bleeding, Deh dehiscence

pad is lubrication during contracture of multiple muscles during follow-up [46]. The exact demographic data such
[44], loss of buccal fat can induce scar contracture and as patient’s age, potential etiology, the size of the lesion,
adhesion of muscles [43]. Therefore, active mouth-open- and postoperative follow-up should be provided in fu-
ing exercise is advised for these patients [43]. Excessive ture reports. As limitation of mouth opening has been
graft taking may also induce cheek depression [40]. reported as a complication of BFP [43], detailed surgical
Although there have been many successful applications protocol about the graft amount should also be sug-
of BFP for the reconstruction of tumors, the method also gested. The overall evidence of BFP application in oral
has limitations. Defect sizes exceeding 4 cm × 4 cm × 3 cm submucous fibrosis seems insufficient.
have higher failure rates [45]. Other authors have also ad-
vised that it should not be used for defects larger than
6 cm × 4 cm [8]. In a previous review, the complication Other applications
rate was 16.4% among 165 cases of BFP graft [45]. The BFP has also been used as an interpositioning material
most frequent complication was breakdown followed by for temporomandibular joint reconstruction. Free fat
postoperative fistula formation [45]. graft from the abdomen is used for the reconstruction of
Oral submucous fibrosis is a precancerous lesion in the the temporomandibular joint, which results in functional
oral mucosa. Mouth opening limitation due to fibrous improvement [51]. In contrast to the abdominal fat, BFP
contracture is a major clinical feature. Abnormal sensation can be used as a pedicled flap because of its anatomical
of oral mucosa is also an accompanying symptom of oral proximity [52]. When BFP is used for gap arthroplasty
submucous fibrosis [46]. As chewing areca nut is reported of the temporomandibular joint, minimal gap (6–7 mm)
to be a potential etiology, oral submucous fibrosis is is advised [53]. The shrinkage rate is reported to be 28%
prevalent in India [46–49] and Taiwan [50]. Complete [53]. If the prepared gap is large, a greater amount of fat is
cure for oral submucous fibrosis has barely been achieved required, and vertical height of the mandibular ramus can-
[50]. Accordingly, functional restoration has been the not be maintained [54]. Compared to temporal fascia graft,
main goal of the treatment.
There have been several reports about the application Table 5 Oral submucous fibrosis treated by BFP
of BFP for the treatment of oral submucous fibrosis. Five Number of Average age Uneventful Compl Ref
papers were included in this review after excluding the patients (range) healing
papers with small sample sizes (≤5) (Table 5). Although 25 34 (17–54) 25 0 [46]
the results have been described as favorable, evaluation 28 NA (18–53) 28 0 [47]
criteria are unclear in most papers. The most important 10 NA NA NA [48]
evaluation criteria for the treatment of oral submucous 20 NA 19 MOL: [49]
fibrosis should be long-term stability of mouth function. 1
When BFP graft was compared to other surgical proto- 16 NA (20–22) NA NA [50]
cols, such as tongue flap, nasolabial flap, and free skin Compl complications, Ref reference number, NA not available, MOL mouth
graft, there was no difference in mouth-opening ability opening limitation
Kim et al. Maxillofacial Plastic and Reconstructive Surgery (2017) 39:5 Page 8 of 9

BFP is resilient and does not have muscle [55]. BFP is 4. Ashtiani AK, Fatemi MJ, Pooli AH, Habibi M (2011) Closure of palatal fistula
stable after grafting into the temporomandibular joint and with buccal fat pad flap. Int J Oral Maxillofac Surg 40(3):250–254
5. Daif ET (2016) Long-term effectiveness of the pedicled buccal fat pad in the
can be detected on MRI 1 year after the operation [56]. closure of a large oroantral fistula. J Oral Maxillofac Surg 74(9):1718–1722
In patients receiving maxillary advancement surgery 6. Adams T, Taub D, Rosen M (2015) Repair of oroantral communications by
by LeFort I osteotomy, the upper lip usually loses its use of a combined surgical approach: functional endoscopic surgery and
buccal advancement flap/buccal fat pad graft. J Oral Maxillofac Surg 73(8):
normal concavity [57]. To improve the upper lip profile, 1452–1456
BFP can be used as an augmentation material [57]. Skull 7. Toshihiro Y, Nariai Y, Takamura Y, Yoshimura H, Tobita T, Yoshino A et al
base defect after tumor surgery also can be repaired by (2013) Applicability of buccal fat pad grafting for oral reconstruction. Int J
Oral Maxillofac Surg 42(5):604–610
BFP [58]. After parotid gland resection, BFP can be used 8. Liu YM, Chen GF, Yan JL, Zhao SF, Zhang WM, Zhao S et al (2006)
for the prevention of Frey syndrome [59]. BFP is also Functional reconstruction of maxilla with BFP, prefabricated titanium mesh
used for repairing perforated maxillary sinus membrane and autologous bone grafts. Int J Oral Maxillofac Surg 35(12):1108–1113
9. Melville JC, Tursun R, Shum JW, Young S, Hanna IA, Marx RE (2016) A
during dental implant surgery [60]. technique for the treatment of oral-antral fistulas resulting from medication-
related osteonecrosis of the maxilla: the combined buccal fat pad flap and
radical sinusotomy. Oral Surg Oral Med Oral Pathol Oral Radiol 122(3):287–291
Conclusions 10. El Deeb M, Roszkowski M, El Hakim I (1990) Tissue response to
Since the introduction of BFP for the reconstruction of hydroxylapatite in induced diabetic and nondiabetic rats: histologic
the maxilla [13], many applications have been introduced. evaluation. J Oral Maxillofac Surg 48(5):476–481
11. Drake DB, Oishi SN (1995) Wound healing considerations in chemotherapy
BFP has many advantages over other types of flaps. The
and radiation therapy. Clin Plast Surg 22(1):31–37
surgical procedure is simple and has shown a high success 12. Colen SR, Shaw WW, McCarthy JG (1986) Review of the morbidity of 300
rate in various applications. BFP can be used in epitheliali- free-flap donor sites. Plast Reconstr Surg 77(6):948–953
zation without additional skin graft. The rich vascularity 13. Egyedi P (1977) Utilization of the buccal fat pad for closure of oro-antral
and/or oro-nasal communications. J Maxillofac Surg 5(4):241–244
of BFP is an advantage when it is used in a poorly vascu- 14. Arce K (2007) Buccal fat pad in maxillary reconstruction. Atlas Oral
larized recipient site. However, its size is a limitation, and Maxillofac Surg Clin North Am 15(1):23–32
repeated usage may not be possible. As the flap is fragile, 15. Singh J, Prasad K, Lalitha RM, Ranganath K (2010) Buccal pad of fat and its
applications in oral and maxillofacial surgery: a review of published
damage to the vascular pedicle may result in graft loss. literature (February) 2004 to (July) 2009. Oral Surg Oral Med Oral Pathol Oral
Removal of too much of the buccal fat pad may induce fa- Radiol Endod 110(6):698–705
cial disfigurement or mouth opening limitation. These 16. Tostevin PM, Ellis H (1995) The buccal pad of fat: a review. Clin Anat 8(6):
403–406
limitations should be considered for the clinical applica- 17. Stuzln JM, Wagstrom L, Kawamoto HK, Baker TJ, Wolfe SA (1990) The
tion of BFP. anatomy and clinical applications of the buccal fat pad. Plast Reconstr Surg
85(1):29–37
Abbreviation 18. Poeschl PW, Baumann A, Russmueller G, Poeschl E, Klug C, Ewers R (2009)
BFP: Buccal fat pad flap Closure of oroantral communications with Bichat’s buccal fat pad. J Oral
Maxillofac Surg 67(7):1460–1466
19. Alkan A, Dolanmaz D, Uzun E, Erdem E (2003) The reconstruction of oral
Acknowledgements
defects with buccal fat pad. Swiss Med Wkly 133(33/34):465–470
This work was carried out with the support of “Cooperative Research
Program for Agriculture Science and Technology Development (Project 20. Abad-Gallegos M, Figueiredo R, Rodríguez-Baeza A, Gay-Escoda C (2011)
No. PJ01121404),” Rural Development Administration, Republic of Korea. Use of Bichat’s buccal fat pad for the sealing of orosinusal communications.
A presentation of 8 cases. Med Oral Patol Oral Cir Bucal 16(2):e215–e219
21. Hanazawa Y, Itoh K, Mabashi T, Sato K (1995) Closure of oroantral
Authors’ contribution communications using a pedicled buccal fat pad graft. J Oral Maxillofac
KMK and KSG wrote the manuscript. HW and KSG did the critical review. All Surg 53(7):771–775
authors read and approved the final manuscript. 22. Nezafati S, Vafaii A, Ghojazadeh M (2012) Comparison of pedicled buccal fat
pad flap with buccal flap for closure of oro-antral communication. Int J Oral
Competing interests Maxillofac Surg 41(5):624–628
The authors declare that they have no competing interests. 23. Hariram, Pal US, Mohammad S, Singh RK, Singh G, Malkunje LR (2010)
Buccal fat pad versus sandwich graft for treatment of oroantral defects: a
Author details comparison. Natl J Maxillofac Surg 1(1):6–14
1
Department of Oral and Maxillofacial Surgery, College of Dentistry, 24. Zhang Q, Li L, Tan W, Chen L, Gao N, Bao C (2010) Application of unilateral
Gangneung-Wonju National University, 7 Jukhyun-gil, Gangneung 25457, pedicled buccal fat pad for nasal membrane closure in the bilateral
Republic of Korea. 2Han Dental Clinic, Guri, Republic of Korea. complete cleft palate. J Oral Maxillofac Surg 68(8):2029–2032
25. Levi B, Kasten SJ, Buchman SR (2009) Utilization of the buccal fat pad flap
Received: 29 December 2016 Accepted: 1 February 2017 for congenital cleft palate repair. Plast Reconstr Surg 123(3):1018–1021
26. Kim YK (2001) The use of a pedicled buccal fat pad graft for bone coverage in
primary palatorrhaphy: a case report. J Oral Maxillofac Surg 59(12):1499–1501
References 27. Musgrave RH, Bremner JC (1960) Complications of cleft palate surgery. Plast
1. Soutar DS, Scheker LR, Tanner NSB, McGregor IA (1983) The radial forearm Reconstr Surg Transplant Bull 26:180–189
flap: a versatile method for intra-oral reconstruction. Br J Plast Surg 36(1):1–8 28. Khouw YL, van der Wal KG, Bartels F, van der Biezen JJ (2004) Bilateral
2. Sadig W, Almas K (2004) Risk factors and management of dehiscent wounds palatal reconstruction using 2 pedicled buccal fat pads in rhinolalea aperta
in implant dentistry. Implant Dent 13(2):140–147 after extensive necrotizing tonsillitis: a case report. J Oral Maxillofac Surg
3. Ashtiani AK, Bohluli B, Kalantar Motamedi MH, Fatemi MJ, Moharamnejad N 62(6):749–751
(2011) Effectiveness of buccal fat in closing residual midpalatal and 29. Gröbe A, Eichhorn W, Hanken H, Precht C, Schmelzle R, Heiland M et al
posterior palatal fistulas in patients previously treated for clefts. J Oral (2011) The use of buccal fat pad (BFP) as a pedicled graft in cleft palate
Maxillofac Surg 69(11):e416–e419 surgery. Int J Oral Maxillofac Surg 40(7):685–689
Kim et al. Maxillofacial Plastic and Reconstructive Surgery (2017) 39:5 Page 9 of 9

30. Nabil S, Ramli R (2012) The use of buccal fat pad flap in the treatment of 56 Gaba S, Sharma RK, Rattan V, Khandelwal N (2012) The long-term fate of
osteoradionecrosis. Int J Oral Maxillofac Surg 41(11):1422–1426 pedicled buccal pad fat used for interpositional arthroplasty in TMJ
31. Marx RE (2009) Reconstruction of defects caused by bisphosphonate-induced ankylosis. J Plast Reconstr Aesthet Surg 65(11):1468–1473
osteonecrosis of the jaws. J Oral Maxillofac Surg 67(5 Suppl):107–119 57 Rubio-Bueno P, Ardanza B, Piñas L, Murillo N (2013) Pedicled buccal fat pad
32. Freiberger JJ (2009) Utility of hyperbaric oxygen in treatment of flap for upper lip augmentation in orthognathic surgery patients. J Oral
bisphosphonate-related osteonecrosis of the jaws. J Oral Maxillofac Surg Maxillofac Surg 71(4):e178–e184
67(5 Suppl):96–106 58 Cherekaev VA, Golbin DA, Belov AI (2012) Translocated pedicled buccal fat
33. Chang DW, Oh HK, Robb GL, Miller MJ (2001) Management of advanced pad: closure of anterior and middle skull base defects after tumor resection.
mandibular osteoradionecrosis with free flap reconstruction. Head Neck J Craniofac Surg 23(1):98–104
23(10):830–835 59 Kim JT, Naidu S, Kim YH (2010) The buccal fat: a convenient and effective
34. Rotaru H, Kim MK, Kim SG, Park YW (2015) Pedicled buccal fat pad flap as a autologous option to prevent Frey syndrome and for facial contouring
reliable surgical strategy for the treatment of medication-related following parotidectomy. Plast Reconstr Surg 125(6):1706–1709
osteonecrosis of the jaw. J Oral Maxillofac Surg 73(3):437–442 60 Kim YK, Yun PY, Oh JS, Kim SG (2014) Prognosis of closure of large sinus
35. Wong JK, Wood RE, McLean M (1997) Conservative management of membrane perforations using pedicled buccal fat pads and a resorbable
osteoradionecrosis. Oral Surg Oral Med Oral Pathol Oral Radiol Endod collagen membrane: case series study. J Korean Assoc Oral Maxillofac Surg
84(1):16–21 40(4):188–194
36. Beumer J, Harrison R, Sanders B, Kurrasch M (1984) Osteoradionecrosis: 61 Alonso-González R, Peñarrocha-Diago M, Peñarrocha-Oltra D, Aloy-Prósper
predisposing factors and outcomes of therapy. Head Neck Surg 6(4):819–827 A, Camacho-Alonso F, Peñarrocha-Diago M (2015) Closure of oroantral
37. Tideman H, Bosanquet A, Scott J (1986) Use of the buccal fat pad as a communications with Bichat’s buccal fat pad. Level of patient satisfaction. J
pedicled graft. J Oral Maxillofac Surg 44(6):435–440 Clin Exp Dent 7(1):e28–e33
38. Samman N, Cheung LK, Tideman H (1993) The buccal fat pad in oral 62 Stajcić Z (1992) The buccal fat pad in the closure of oro-antral
reconstruction. Int J Oral Maxillofac Surg 22(1):2–6 communications: a study of 56 cases. J Craniomaxillofac Surg 20(5):193–197
39. Fujimura N, Nagura H, Enomoto S (1990) Grafting of the buccal fat pad into 63 Baumann A, Ewers R (2000) Application of the buccal fat pad in oral
palatal defects. J Craniomaxillofac Surg 18(5):219–222 reconstruction. J Oral Maxillofac Surg 58(4):389–392
40. Hao SP (2000) Reconstruction of oral defects with the pedicled buccal fat 64 Jain MK, Ramesh C, Sankar K, Lokesh Babu KT (2012) Pedicled buccal fat pad
pad flap. Otolaryngol Head Neck Surg 122(6):863–867 in the management of oroantral fistula: a clinical study of 15 cases. Int J
41. Zhong LP, Chen GF, Fan LJ, Zhao SF (2004) Immediate reconstruction of Oral Maxillofac Surg 41(8):1025–1029
maxilla with bone grafts supported by pedicled buccal fat pad graft. Oral 65 Chaudhary B, Gong Z, Lin Z, Abbas K, Ling B, Liu H (2014) Reconstruction of
Surg Oral Med Oral Pathol Oral Radiol Endod 97(2):147–154 intraoral maxillary defect with buccal fat pad. J Craniofac Surg 25(6):2174–2177
42. Vuillemin T, Raveh J, Ramon Y (1988) Reconstruction of the maxilla with bone
grafts supported by the buccal fat pad. J Oral Maxillofac Surg 46(2):100–106
43. Colella G, Tartaro G, Giudice A (2004) The buccal fat pad in oral
reconstruction. Br J Plast Surg 57(4):326–329
44. Yousuf S, Tubbs RS, Wartmann CT, Kapos T, Cohen-Gadol AA, Loukas M
(2010) A review of the gross anatomy, functions, pathology, and clinical
uses of the buccal fat pad. Surg Radiol Anat 32(5):427–436
45 Rapidis AD, Alexandridis CA, Eleftheriadis E, Angelopoulos AP (2000) The use
of the buccal fat pad for reconstruction of oral defects: review of the
literature and report of 15 cases. J Oral Maxillofac Surg 58(2):158–163
46 Mehrotra D, Pradhan R, Gupta S (2009) Retrospective comparison of surgical
treatment modalities in 100 patients with oral submucous fibrosis. Oral Surg
Oral Med Oral Pathol Oral Radiol Endod 107(3):e1–e10
47 Sharma R, Thapliyal GK, Sinha R, Menon PS (2012) Use of buccal fat pad for
treatment of oral submucous fibrosis. J Oral Maxillofac Surg 70(1):228–232
48 Rai A, Datarkar A, Rai M (2014) Is buccal fat pad a better option than
nasolabial flap for reconstruction of intraoral defects after surgical release of
fibrous bands in patients with oral submucous fibrosis? A pilot study: a
protocol for the management of oral submucous fibrosis. J Craniomaxillofac
Surg 42(5):e111–e116
49 Lambade P, Dawane P, Thorat A (2016) Efficacy of buccal fat pad in the
surgical management of oral submucous fibrosis: a prospective study. Oral
Maxillofac Surg 20(2):167–170
50 Chao CK, Chang LC, Liu SY, Wang JJ (2002) Histologic examination of
pedicled buccal fat pad graft in oral submucous fibrosis. J Oral Maxillofac
Surg 60(10):1131–1134
51 Wolford LM, Karras SC (1997) Autologous fat transplantation around
temporomandibular joint total joint prostheses: preliminary treatment
outcomes. J Oral Maxillofac Surg 55(3):245–251
52 Rattan V (2006) A simple technique for use of buccal pad of fat in
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53 Bansal V, Bansal A, Mowar A, Gupta S (2015) Ultrasonography for the
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54 Singh V, Dhingra R, Sharma B, Bhagol A, Kumar P (2011) Retrospective 7 Open access: articles freely available online
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55 Singh V, Dhingra R, Bhagol A (2012) Prospective analysis of
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graft and buccal fat pad lining. J Oral Maxillofac Surg 70(4):997–1006