Anatomy of the buccal fat pad for structures at risk during bichatectomy 

Purpose: To determine the volume of the buccal fat pad (BFP), and its relationship with the upper 2nd molar and the facial artery (FA). Methods: : A cross-sectional, observational study. Computed tomography was used to obtain 3D images to determine volume, length, and width. Distances from the 2nd molar to each extension, and the nearest distance to the FA. Results: : A total of 106 BFP (70 male) were included. The mean age was 51±21. The mean volume, length, and width were 13.8±5.4mL, 72.9±10.7mm, and 21.4±5.6mm, respectively. The BFP extends mainly cephalic and caudally from the second molar, reaching upto 8.5 cm and 32mL. The mean distance between the second molar and FA was 12.9mm, but as close as 3mm. The FA had a mean distance of 2.1mm to the nearest BFP extension, with 42.5% in intimate contact, and another 9.4% crossing the center of the masseter extension. There were no statistically significant differences between sexes. Conclusions: : The BFP has a dynamic shape with highly variable size and volume. Although removed for cosmetic procedures or reconstructive purposes, the FA is often at risk of damage during procedures due to its proximity. Procedures must be performed by highly trained medical professionals with anatomical knowledge of its morphometry and variability.