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

The buccal fat pad (BFP), is an adipose tissue located in the cheek, with complex morphology. Oral bichatectomy is a frequent aesthetic procedure with possible complications. Our objective was to determine the volume and its relationship with the upper 2^nd molar and the facial artery (FA). A cross-sectional, observational study was performed. Computed tomography was used to obtain 3D images to determine volume, length, and width. Distances from the 2^nd molar to each extension, and the nearest distance to the FA were measured. A total of 106 BFP (70 male) were included. The mean age was 51±21. The mean volume, length, and width were 13.8±5.4 ml, 72.9±10.7 mm, and 21.4±5.6 mm, respectively. The BFP extends mainly cephalically and caudally from the second molar, reaching upto 8.5 cm and 32 ml. The mean distance between the second molar and FA was 12.9 mm, but as close as 3 mm. 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. The BFP has a dynamic shape with highly variable size and volume. The FA is often at risk of damage during procedures due to proximity.