Ruzhytska O.V. Application of the buccal fat pad of patients with different types of face in the surgical treatment of defects of alveolar processes of jaws. – Thesis manuscript.
The thesis for the Candidate degree in Medical Sciences in specialty 14.01.22 – Dentistry. – Danylo Halytsky Lviv National Medical University, Ministry of Health of Ukraine, Lviv, 2020.
The thesis is devoted to solving the current scientific and practical problem of modern surgical dentistry and maxillofacial surgery – increasing the efficiency of surgical treatment of defects of the alveolar processes of the jaws by individualized application of the approach to obtaining and autografting of the BFP taking into account the structure of different patients’ types of face by conducting pathologic anatomical, clinical, radiographic, and sonographic studies.
During pathologic anatomical examinations, the topographic and anatomical features of the buccal area were studied, the condition of the buccal fat pad at its autopsy in patients was analyzed according to its anatomical and topographic location, planimetric, and biometric characteristics depending on the type of face, age, and gender.
In the study of morphological biometric parameters of the BFP, the buccal region of the human face was found to have a number of topographic and anatomical features that prove that the BFP is a separate morpho-functional structure. It has its own fascial capsule containing loose connective tissue, a vascular network with formed accumulations of adipose tissue present within the buccal triangle – from the anterior edge of the masseter to the nasolabial fold and to the zygomatic bone.
Morphological studies have shown that the BFP size, its volume, and weight are directly proportional to the type of face. The average area of the BFP is 10–12 cm2, and the volume is 4.0–4.5 cm3. The largest dimensions of BFP are observed in people with brachyfacial (BF) type of face. The smallest dimensions have been established in people with dolichofacial (DF) type of face. The average BFP size was closer to larger dimensions in people with mesofacial (MF) type of face. Thus, the obtained data prove that the favorable morphological location, high vascularization, different biometric parameters in patients with different face types, allow differentiated use of BFP for surgical replacement of tissue defects of the alveolar processes of the jaws (TDAPJ).
As a result of clinical studies, a new approach to the diagnosis of the BFP location has been proposed and surgical treatment of patients with defects of alveolar processes of jaws have been substantiated that enable individualized replacement of tissue defects of alveolar processes in patients with different facial types. Differentiated algorithms of surgical treatment with the choice of approach, sampling, and autografting of the BFP in patients with different types of face have been developed.
The identified features of clinical and instrumental indicators of examination of patients with different facial types demonstrate the differential distinction of morpho-functional state of surgical sites and may serve as specific indicators of individualized choice of surgical approach in BFP autografting. These include the sufficiency of BFP biometric parameters to close minor or major tissue defects, atraumatic access to the donor site, the need for additional traction of the buccal corridors, the choice of location, direction, type, and length of intraoral incision of buccal tissues.
The obtained results of the scientific study have substantially proven the increased efficiency of BFP autografting during surgical treatment of TDAPJ by the differentiated approach of clinical and instrumental examination and individualized choice of method of surgical intervention taking into account patients’ types of face, which enables us to recommend it for practical use in modern dentistry and maxillofacial surgery.
Keywords: buccal fat pad, dolichofacial, mesofacial, brachyfacial types of face, defects of alveolar processes of jaws, surgical treatment.
