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Post-Bichat Sialocele and Parotid Complications: Cystectomy Techniques, Developments, and Respiratory Issues
Abstract
Introduction: Bichatectomy is one of the most common facial surgeries, but it can be performed by all hands. The complication and most difficult to treat is Sialocele. That’s why we have developed a simple method to treat and resolve them. Surgical Approach: We present a case of a young woman who developed a tumor in her midface 5 days after double mouth resection. Therefore, we decided to create a new narrow canal with drainage in an anatomical location. Good results have been obtained so far. Discusion: The bichectomy has an important historical background, as although it was originally a surgery, it had no meaning in the medical field. Bichat fat removal is currently performed for cosmetic rather than reconstructive purposes, so an enlargement of the salivary sac by more than 3% occurs independent of the surgeon’s hands. Conclusion: Considering the complications of bichatectomy, we decided to create an alternative for surgeons in training and find a simple solution.
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The present study seeks to provide knowledge and important aspects of the anatomical structures associated with the buccal fat pad (BFP), as consequence of the report of a case of complication after bichectomy. Knowing the anatomical elements and their relationships with BFP is of vital importance, because nowadays there are too many BFP removal courses and internships, for general dentists and specialists, due to the increasing aesthetic demands of individuals seeking a finer and more stylized profile. The case presented is a female patient who consults the emergency department for an increase in facial volume after BFP extraction, which was diagnosed as sialocele, following damage to the parotid duct. When reviewing the literature and observing our anatomical preparations, the proximity of important elements is appreciated, such as the parotid duct, the zygomatic and buccal branches of the facial nerve, facial vessels such as the facial artery, facial vein and facial transverse artery. It is essential to know in detail the area in order to intervene and consider the possible anatomical variations of these elements to avoid injury during the procedure. The aimed objective of this study, is to provide accurate and concise anatomical information of important elements near or immersed in BFP, to prevent iatrogenesis.
Background
In recent years, the number of procedures for buccal fat pad removal has increased. In cases of thinning of the face, bite injuries or bruxism, partial removal of the corpuscle is performed, always taking into account facial harmonization.
Objective
The aim of the present study was to demonstrate the post-operative procedure of the removal of the BFP by pain parameters, mouth opening and presence of edema. This longitudinal cohort study was registered in clinical trials and all participants had access to the informed consent form.
Methods
Forty BFP removal surgeries were performed with the technique of intraoral access. After the bichectomy procedure, the individuals were followed for 4, 7, 10, 15, 30, and 90 days. Visual pain scale, mouth opening measurements and clinical visual assessment were performed at all times.
Results
We observed that the presence of edema and limited mouth opening for about 15 days were the changes most commonly found in surgeries performed. The results showed a significant decrease in painful symptoms after 15 days, regarding mouth opening, the results showed a return to normal levels after 30 days (p <0.05), the presence of edema ceased after 15 days.
Conclusion
We conclude that the BFP removal, when performed following a precise indication, properly and with the recommendations of post-operative care, followed correctly, promotes limitation in mouth opening and painful symptoms by 15 days.
The procedure is becoming a new area for the dental surgeon, who can perform the procedure safely, reliably and with aesthetic and therapeutic results.
Objective: To know the great contribution made by Bichat as a pioneer of the anatomoclinical methods, by considering the anatomical lesion as the foundation of the clinical knowledge, it was possible to make the transition from medicine to a truly scientific discipline. Starting with Bichat, the foundation of disease stops being distant and abstract and becomes a very concrete concept. Design: Historical assay (10 references). Result: Bichat was the first to introduce the notion of tissues as distinct entities, approaching their study from a purely sensorial point of view, leading to the fall of the fibrilarist theory in force since the XVI century. He was able to identify, describe, and classify 21 tissues, which he pointed out as elemental structures of the diverse organs. According to the concept of ''general anatomy'', Bichat considered organs as structures formed by several tissues that could become diseased independently (since they were the site of the morbid process) and not as an indivisible whole. Bichat saw the tissue as a continuous and fundamental structure of the whole organism and addressed his attention to it and not toward the isolated organs, as had been indicated by Giovanni Batista Morgagni. Conclusion: Thanks to the advances achieved by the anatomoclinical methods, French medicine became the leader of worldwide medicine at the beginning of the XIX century and was able to keep that place for at least one century.
This article presents an overview of the history of the buccal fat pad flap, its relevant anatomy, and its indications and contraindications. The surgical technique for its harvest is described, as are the postoperative care and possible complications.
The buccal fat pad is a trigone-shaped adipose tissue located in the cheek that assumes numerous functional and aesthetic clinical uses. It has been studied extensively within the past four decades, and its use in repairing common and debilitating oral defects is the motive for continued research on this topic. It is vital to understand the etiology of any oral defect or of a lesion of the buccal fat pad, for a misdiagnosis can prevent effective treatment of the underlying problem. In this review, we describe the embryology and anatomy of the buccal fat and its association with clinical condition and clinical procedures.
The buccal fat pad is an anatomically complex structure that has great importance in facial contour. In properly selected individuals, judicious harvesting of buccal fat can produce dramatic changes in facial appearance by reducing the fullness of the cheek and highlighting the malar eminences. Using fresh cadaver dissection, the anatomy of the buccal fat pad is delineated and its relationship to the masticatory space, facial nerve, and parotid duct is defined. An intraoral approach for buccal fat harvesting is described based on these anatomic findings. Clinical experience manipulating the buccal fat pad for aesthetic modification of facial contour is illustrated.
Comparative between Buccal and Vestibular Approaches for Bichectomies
- Araujo Lopez
- A Rrodriguez
- M G Martínez
Araujo Lopez A, Rrodriguez MG, Martínez HO, et al.
Comparative between Buccal and Vestibular Approaches for
Bichectomies. J Surg. 2023;8(3):1-5.
Bichectomía: técnica del tridente, presentación de una nueva técnica quirúrgica
- J P Brito-Vera
- L D Gómez-Barajas
- D R Santana-Montes
Brito-Vera JP, Gómez-Barajas LD, Santana-Montes DR, et al.
Bichectomía: técnica del tridente, presentación de una nueva
técnica quirúrgica. AN Orl Mex. 2020;65(1):37-42.