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    Dierks - Buccal Fat Pad and Tongue Flaps Indy 2019

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    lippincott2011
    This document provides an overview and summary of a modular course on buccal flap and tongue flap techniques presented by Dr. Eric Dierks. The course covers the anatomy and surgical techniques for harvesting buccal fat pad ("Buckie") flaps and various tongue flaps for reconstruction of oral defects. Applications of these flaps are discussed, including closure of oroantral fistulae and reconstruction of defects from tumor resection or osteomyelitis. Key steps in harvesting the flaps gently are emphasized. Post-operative management and expected healing timelines are reviewed. References are provided for further reading on the anatomy and clinical applications of these important pedicled flap techniques.

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    Dierks - Buccal Fat Pad and Tongue Flaps Indy 2019

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    lippincott2011
    44 views76 pages
    This document provides an overview and summary of a modular course on buccal flap and tongue flap techniques presented by Dr. Eric Dierks. The course covers the anatomy and surgical techniques for harvesting buccal fat pad ("Buckie") flaps and various tongue flaps for reconstruction of oral defects. Applications of these flaps are discussed, including closure of oroantral fistulae and reconstruction of defects from tumor resection or osteomyelitis. Key steps in harvesting the flaps gently are emphasized. Post-operative management and expected healing timelines are reviewed. References are provided for further reading on the anatomy and clinical applications of these important pedicled flap techniques.

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    This document provides an overview and summary of a modular course on buccal flap and tongue flap techniques presented by Dr. Eric Dierks. The course covers the anatomy and surgical techniques for harvesting buccal fat pad ("Buckie") flaps and various tongue flaps for reconstruction of oral defects. Applications of these flaps are discussed, including closure of oroantral fistulae and reconstruction of defects from tumor resection or osteomyelitis. Key steps in harvesting the flaps gently are emphasized. Post-operative management and expected healing timelines are reviewed. References are provided for further reading on the anatomy and clinical applications of these important pedicled flap techniques.

    Copyright:

    © All Rights Reserved
    Download as PPSX, PDF, TXT or read online from Scribd
    Download as ppsx, pdf, or txt
    44 views76 pages

    Dierks - Buccal Fat Pad and Tongue Flaps Indy 2019

    Uploaded by

    lippincott2011
    This document provides an overview and summary of a modular course on buccal flap and tongue flap techniques presented by Dr. Eric Dierks. The course covers the anatomy and surgical techniques for harvesting buccal fat pad ("Buckie") flaps and various tongue flaps for reconstruction of oral defects. Applications of these flaps are discussed, including closure of oroantral fistulae and reconstruction of defects from tumor resection or osteomyelitis. Key steps in harvesting the flaps gently are emphasized. Post-operative management and expected healing timelines are reviewed. References are provided for further reading on the anatomy and clinical applications of these important pedicled flap techniques.

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    © All Rights Reserved
    Download as PPSX, PDF, TXT or read online from Scribd
    Download as ppsx, pdf, or txt
    of 76

    S.O.R.G.

    Modular Course Series

    Eric Dierks Portland, Oregon USA

    Buccal Flap and Tongue Flap

    Indianapolis, IN | April 5 – 7
    BUCCAL FAT PAD AND
    TONGUE FLAPS

    Eric J. Dierks, MD, DMD, FACS, FACD, FRCS(Ed)


    Head and Neck Surgical Associates
    Head and Neck Institute
    Affiliate Professor of Oral and Maxillofacial Surgery
    Oregon Health & Science University
    Portland, Oregon USA
    Buccal Fat Pad Flap
    The Fat Pad of Bichat
    Marie Francois Xavier Bichat: 1801
    • Fat pad was not a gland

    Peter Egyedi: 1977


    • described BFP as a rotational flap for oral
    reconstruction
    J Maxillofacial Surg 1977

    Henk Tideman: 1986


    • BFP readily epithelializes in 2-3 weeks
    when brought into the oral cavity
    JOMS 1986
    Scammon 1918
    Buccal fat pad flap: “Buckie”
    Blood supply:
    • Maxillary artery
    – Buccal br
    – Deep temporal br
    • Superficial temporal artery
    – Transverse facial br.
    • Facial artery
    – Multiple small br.
    Lobes and
    extensions
    3 lobes:
    • Anterior
    • Intermediate
    • Posterior: 4 extensions
    – Buccal*
    – Pterygoid
    – Pterygopalatine
    – Temporal
    Buccal fat pad
    “Syssarcosis”

    Lies between:
    Buccinator - medial
    Masseter - lateral

    Thin fascial envelope


    Mean volume: 10ml
    Anatomy
    Retromolar trigone defect
    BFP “ Buckie” used to
    cover trans oral bone
    graft
    Buckie fills in defect after
    osteomyelitis marginal resection
    Morphology is more like
    orbital fat

    • Function: in infants: resists negative


    pressure on cheek during suckling

    • Size: Uniform size and shape regardless of


    nutritional status or obesity

    Racz and Maros, Morphol-Embryol 1989


    Buccal fat pad flap
    applications:

    • Closure:
    – oral-antral fistulae*
    • Coverage:
    – retromolar trigone
    – marginal
    mandibulectomy
    – soft palate
    – buccal defects from
    submucous fibrosis
    release
    Surgical approaches to harvest Buckie:
    Srivastava

    1.. An incision through the mucosa on the buccal


    aspect of the vestibule in the molar region.
    2.. A vertical mucosal incision slightly lateral to the
    anterior margin of the ascending ramus (fig 4).
    3. Elevate mucoperiosteal flap in the molar region
    on the lateral aspect of the maxillary alveolar
    process and incision of the periosteum at the level
    of buccal sulcus
    Approach
    Be
    gentle…

    Harvest
    • BFP may be visible through defect
    • Dean scissors + Debakey forceps
    - “extracapsular dissection”
    • Release BFP along margin you need to
    advance
    Instrumentation

    DeBakey forceps
    Dean scissors
    Adequate access
    • Large incision
    • Don’t pull Buckie out
    • Let him flow out

    Johan Fagan MBChB, FCORL


    Professor and Chairman
    Division of ENT
    University of Cape Town
    SCCA lateral soft
    palate
    Baumann and Ewers JOMS 2000

    • N= 29 patients
    • Largest defect = 4 X
    5.5 cm
    • Epithelialization
    within 3-4 wks
    Shrivastava et al, Buccal Fat Pad to Repair Intraoral Defects
    International Journal of Scientific and Research Publications,
    Volume 3, Issue 2, February 2013 1 - 6
    Shrivastava et al

    10 days 3 months
    Post op course
    what to inform your patients
    The Buckie Owners Manual

    • Granulating surface
    – It looks terrible!
    – And it smells!
    • Granulates to a
    beautiful mucosal
    surface in about 3-5
    weeks
    • Trismus: 1-2 months
    – may require physical
    therapy
    OA Fistula 3 molar area
    rd
    OA Fistula 3 molar area
    rd
    OA Fistula 1 molar area
    st
    The Jurassic Period
    “Only a man who is familiar with the art and
    science of the past is competent to aid in its
    progress in the future.”
    – Theodor Billroth, 1863
    OA Fistula 1 molar area
    st
    OA Fistula 1 molar area
    st
    OA Fistula 1 molar area
    st
    Maxillary alveolar ridge defect
    Approx 2 weeks later
    Approx 3 weeks later
    Small SCCa buccal mucosa
    Approx 2 weeks later
    Bilateral BFP: David Hirsch MD, DDS
    TONGUE FLAP
    Tongue flap:
    Sites of harvest
    • Midline most commonly used
    • Hemi-tongue set-back
    • Lateral
    • Anterior, bipedicle
    • Posterior
    History of tongue flappage:

    1901 von Eiselberg & Gersuny


    1904 Ranzi & Sultan
    1956 Kloop described use for oral
    reconstruction
    1972 Ian Jackson described tongue
    flap for closure of palatal fistulas
    1966 Guerro-Santos
    4 branches of lingual artery:

    suprahyoid
    deep lingual
    dorsal lingual
    sublingual
    Anterior median tongue flap:
    • location: middle 1/3 of tongue
    • width: > than defect width
    • length: ~ 5 cm
    • thickness: ~ 4 - 5 mm
    • fixation: 3 weeks
    • IMF: rarely needed
    Midline tongue flaps:
    35 specimens

    • anastomotic arcades cross midline at tongue tip


    - may support anterior based flaps
    • posteriorly based flaps fill better, but midline
    flaps can be perfused from either end
    • submucosal plexus fills before muscle
    - Bracka, Br J Plast Surg, 1981
    Midline tongue flaps for oral fistulae:

    • palatal fistulae> 1.5 cm diameter


    • all cleft palate breakdowns
    • flap length 5 - 6 cm
    • thickness: 5 - 7 mm with 2 - 4 mm muscle
    • IMF for 2 - 3 days 
    • pedicle division @ 3 weeks
    • 17/19 successful

    - Busic et al. Int J Oral Maxillofac Surg, 1989


    Anterior median tongue flap
    applications:

    • oral-nasal/antral fistulae
    • alveolar clefts
    • other median and paramedian defects
    Anteriorly based, midline tongue flap
    very useful

    Prior radiation therapy


    Anteriorly based, midline tongue flap

    • oral-nasal/antral fistulae
    • alveolar clefts
    • other median and paramedian defects
    Rotational flap ?
    Looks good in pictures
    usually doesn’t work
    Stage 1 overview
    You can’t directly close the posterior aspect
    of the fistula
    Stage 2: 3 weeks later
    Methods to avoid tongue flap detachment
    Agrawal and Panda PRS 2007

    IMF

    K-wire fixation !

    Chin cap !!
    Set-back tongue flap

    Seidl et al, HNO 2003


    Tongue tip reconstruction with
    dorsal/ventral
    reversed Z-plasties
    Posteriorly based
    lateral tongue flap

    • tonsillar defects
    • lateral pharyngeal wall defects
    •Rarely used
    Palatal flap
    based on opposite greater palatine artery
    Greater palatine artery axial flap

    Trick #1:
    • Sharply separate the greater palatine artery
    from the undersurface of the flap in the area
    of potential kinking
    Greater palatine artery axial flap

    Trick #2:
    • Curette away bone around the greater
    palatine foramen
    • Enlarge the foramen
    • Allows rotation of the vessel without kinking
    Post-rotational Flap Floposis
    Correction of Flap Floptosis
    Greater palatine artery axial flap

    Trick #3:
    • Avoid flap flaptosis by suturing flap to palate
    • Consider paired, drilled or punched holes to
    suture through
    One year later
    [email protected]
    • Yousuf S, Shane Tubbs R, Wartmann CT, Kapos T, Cohen-Gadol AA, Loukas M. A review of the gross anatomy, functions, pathology, and
    clinical uses of the buccal fat pad. Surg Radiol Anat. 2009 Nov 25.

    • Paul W. Poeschl, Arnulf Baumann, Guenter Russmueller, Ellen Poeschl, Clemens Klug, Rolf Ewers Closure of Oroantral Communications With
    Bichat's Buccal Fat Pad JOMS, Vol 67:7, July 2009, pp 1460-1466

    • Egyedi P. Utilization of the buccal fat pad for closure of oro-antral and/or oro-nasal communications.J Maxillofac Surg. 1977 Nov;5(4):241-4.
    •  
    • Samman N, Cheung LK, Tideman H. The buccal fat pad in oral reconstruction. Int J Oral Maxillofac Surg. 1993 Feb;22(1):2-6.
    •  
    • Hudson JW, Anderson JG, Russell RM Jr, Anderson N, Chambers K. Use of pedicled fat pad graft as an adjunct in the reconstruction of palatal
    cleft defects. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 1995 Jul;80(1):24-7.
    •  
    • Rapidis AD, Alexandridis CA, Eleftheriadis E, Angelopoulos AP.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. 2000 Feb;58(2):158-63.
    •  
    • Jackson IT.Anatomy of the buccal fat pad and its clinical significance. Plast Reconstr Surg. 1999 Jun;103(7):2059-60.11. Zhang HM, Yan YP, Qi
    KM, Wang JQ, Liu ZF. Anatomical structure of the buccal fat pad and its clinical adaptations. Plast Reconstr Surg.109:2509, 2002.
    •  
    • Baumann A, Ewers E. Application of the buccal fat pad in oral reconstruction. J Oral Maxillofac Sur. 58:389, 2000.
    •  
    • Colella G, Tartaro G, Giudice A. The buccal fat pad in oral reconstruction. Br J Plast Surg. 57:326, 2004.
    •  
    • Jackson IT, Moreira-Gonzalez AA, Rogers A, Beal BJ.The buccal flap--a useful technique in cleft palate repair Cleft Palate Craniofac J. 2004
    Mar;41(2):144-51
    •  
    • Alkan A, Dolanmaz D, Uzun E, Erdem E. The reconstruction of oral defects with buccal fat pad. Swiss Med Wkly. 23:465, 2003.
    •  
    • Rapidis AD, Alexandridis CA, Eleftheriadis E, Angelopoulos AP. 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. 85:29, 2000.
    •  
    • el-Hakim IE, el-Fakharany AM.The use of the pedicled buccal fat pad (BFP) and palatal rotating flaps in closure of oroantral communication
    and palatal defects. J Laryngol Otol. 1999 Sep;113:834-8.
    Egyedi P. Utilization of the buccal fat pad for closure of oro-antral and/or oro-nasal communications.J
    Maxillofac Surg. 1977 Nov;5(4):241-4.
     
    Samman N, Cheung LK, Tideman H. The buccal fat pad in oral reconstruction. Int J Oral Maxillofac Surg. 1993
    Feb;22(1):2-6.
     
    Hudson JW, Anderson JG, Russell RM Jr, Anderson N, Chambers K. Use of pedicled fat pad graft as an adjunct
    in the reconstruction of palatal cleft defects. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 1995
    Jul;80(1):24-7.
     
    Rapidis AD, Alexandridis CA, Eleftheriadis E, Angelopoulos AP.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. 2000 Feb;58(2):158-63.
     
    Jackson IT. Anatomy of the buccal fat pad and its clinical significance. Plast Reconstr Surg. 1999
    Jun;103(7):2059-60.11. Zhang HM, Yan YP, Qi KM, Wang JQ, Liu ZF. Anatomical structure of the buccal fat pad
    and its clinical adaptations. Plast Reconstr Surg.109:2509, 2002.
     
    Baumann A, Ewers E. Application of the buccal fat pad in oral reconstruction. J Oral Maxillofac Sur. 58:389,
    2000.
     
    Colella G, Tartaro G, Giudice A. The buccal fat pad in oral reconstruction. Br J Plast Surg. 57:326, 2004.
     
    Jackson IT, Moreira-Gonzalez AA, Rogers A, Beal BJ.The buccal flap--a useful technique in cleft palate repair
    Cleft Palate Craniofac J. 2004 Mar;41(2):144-51
     
    Alkan A, Dolanmaz D, Uzun E, Erdem E. The reconstruction of oral defects with buccal fat pad. Swiss Med
    Wkly. 23:465, 2003.
     
    Rapidis AD, Alexandridis CA, Eleftheriadis E, Angelopoulos AP. 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. 85:29, 2000.
     
    el-Hakim IE, el-Fakharany AM.The use of the pedicled buccal fat pad (BFP) and palatal rotating flaps in closure
    of oroantral communication and palatal defects. J Laryngol Otol. 1999 Sep;113:834-8.

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