CT ANATOMY OF BUCCAL FAT PAD AND ITS ROLE IN VOLUMETRIC ALTERATIONS OF FACE

Abstract. The aim of our study is the revision of the anatomy of buccal fat pad and its role in a volumetric pattern of face. Bichat fat pad is a fatty anatomical structure with body and numerous process enclosed between the bony and muscular structures in temporal, pterygopalatine fossae and extents to the cheek area. Nevertheless, the opinion about its structure and role in forming of volume pattern of face sometimes could be controversial. The Bichat fat pad consists on predominately hormone insensitive fat tissue with underdeveloped stroma, this leads to the stability of the fat pad volume and lesser radiodensity in contrast to the subcutaneous fat. Moreover, the buccal fat pad is delimited from the subcutaneous fat of cheek area by the strong capsule. This feature allows us to use CT to divide the Bichat fat pad from the surrounding tissues. The thorough embryological data provide the distinction of Bichat fat pad from the subcutaneous fat of cheek area even at the stage of development. On the other hand, the border between the masticatory muscles and the processes of the fat pad is not evident and resembles cellular spaces in the other anatomical areas. To elicit the role of the buccal fat pad in volume pattern of face and its function we have performed the several experiments, analyzed the postoperative results after Bichat fat pad resection using surface scanner and CT data. At first, we have performed the gravity test: the patient’s face photogrammetry scanning in horizontal and vertical position of head and it revealed the excess of volume in temporal area in horizontal position. To exclude mechanism of overflowing of the skin and subcutaneous fat over the zygomatic arch we have placed the markers on the skin surface at the different areas of face including the projection of ligaments and found out that the migration of soft tissue over the zygomatic arch is about 3-5 mm and almost the same in temporal area. However, the acquired result was unsatisfying because cannot exclude completely the migration of superficial tissues. In following experiments it was shown that the intensive pressure on the cheek area in vertical position produce the volume excess in the temporal area similar and more exaggerate than in gravity test. To correlate the excess of tissue with underlying anatomical structures we had acquired the CT’s of some probationers, performed 3D reconstruction of bony structures, Bichat fat pad, and aligned with the previous surface scans. The projection of this excess in both experiments corresponds with the temporal process of Bichat fat pad. That means that the leading mechanism of these changes is protrusion of temporal process of Bichat fat pad through the leaves of temporal fascia due to pressure on the buccal extension: in these conditions, the buccal fat pad works as a communicating vessel between the cheek area and temporal fossa. This fact has suggested us that the phenomenon of the deepening of temporal area during the ageing could be produced as by the atrophy of buccal fat pad as by the migration of the fat pad to the cheek area due to ptosis.