Peculiarities of surgical treatment of jaw defects by applying buccal fat pad in patients with various face types

Abstract

Aim. To evaluate the results of buccal fat pad use in the surgical treatment of jaws defects in patients with different face types. Materials and Methods. The study was conducted on 17 patients aged from 23 to 67 years, both male and female, with defects of alveolar processes of the jaws. Out of total, 7 (41.2%) patients had a mesofacial face type, 5 (29.41%) had a brachifacial face type and 5 (29.41%) patients had a doliofacial face type. The buccal fat pad was used for treating the defects of the alveolar processes of the jaws. Results and Discussion. The established values of clinical indicators of cheek thickness, external and internal buccal corridor size, as well as additional data of ultrasonographic determination of forms and parameters of buccal fat pad thickness and radiographic values, allow making a differentiated choice of location, length of incisions, non-traumatic approaches to autograft area, and establishing recommendations for biometrical adequacy of autograft for individualized replacement of tissue defects of the alveolar processes of jaws in patients with different types of the face. In patients with mesofacial face type , it is recommended to choose the starting point of incision in the anterior region of the buccal triangle, located at a distance of 29.3 mm from the occlusal surface of the upper molars; the optimal length of the incision is within 2 cm, after an atraumatic tissue retraction, the possible autologous graft area is 9.9 cm2, up to 5 cm3 in size and 5.3 mm thick, which is sufficient for surgical treatment of volumetric defects of the alveolar processes of the jaws. In patients with brachyfacial face type , it is advisable to choose the starting point of incision in the middle and the posterior part of the buccal triangle, located at a distance of 23.5 mm from the occlusal surface of the upper molars; the length of the incision should not exceed 3 cm; for retraction of tissues, their forced removal or additional instrumental mobilization should be applied, with subsequent autograft excision up to 15.0 cm2, with a size up to 5.7 cm3 and thickness of 6.7 mm, which is sufficient for surgical treatment of volumetric tissue defects of the alveolar processes of the jaws. In patients with doliofacial face type , the starting point of incision in the posterior part buccal triangle at a distance of 38.5 mm from the occlusal surface of the upper molars; the length of the cut should be within 1.5 cm, with the following atraumatic retraction of tissue buccal areas for intake of buccal fat pad of 9,5 сm2, with a size up to 3,6 cm3 and thickness up to 3.9 mm, which is sufficient for the surgical treatment of minor tissue defects of the alveolar processes of the jaws. In patients with mesofacial face type, a positive result of individualized auto-transplantation of the buccal fat pad was subjectively established in all clinical cases, while objectively only in 71% of patients primary healing of tissue defects was revealed. In patients with brachyfacial face type, subjectively positive result was found in 40% of cases, while objectively in 80% of patients healing of tissue defects was found. In all patients with dolihofacial type, primary healing of tissue defects was found. Conclusion. The final evaluation of the effectiveness of the proposed individualized approach, taking into account the types of people's faces, shows positive results of autotransplantation of the buccal fat pad in surgical treatment of patients with tissue defects of the alveolar processes of the jaws.

Keywords

• buccal fat pad, tissue defects of alveolar processes, autotransplantation,meso-, brachy- and dolihofacial face types