Buccal fat pad

The buccal fat pad is an encapsulated mass of adipose tissue situated on either side of the face. It lies outer to the buccinator muscle and deep to several facial expression muscles, including the masseter, zygomaticus major, and zygomaticus minor. It is one of several distinct fat compartments in the cheek and plays important roles in mastication, facial contour, and muscular protection.

Anatomical Location and Relations

• Position: Deep fat pad of the cheek, located between:

  • Medially: Related to buccinator muscle

  • Laterally: Related to masseter and zygomatic muscles

• The inferior part of the buccal fat pad occupies the buccal space.

• It should not be confused with the malar fat pad or the jowl fat pads.

• The buccal fat pad contributes to the fullness of the cheek and is implicated in the nasolabial fold and hollow cheeks when atrophic, but not in the formation of jowls.

Lobar and Extension Anatomy

The buccal fat pad has been believed to have been divided into three lobes and four extensions:

1. Lobes

• Anterior lobe

  • Surrounds the parotid duct (Stensen’s duct).

• Intermediate lobe

  • Lies between anterior and posterior lobes, overlying the maxilla.

• Posterior lobe

  • Extends from the infraorbital fissure and temporal muscle to the upper border of the mandible and mandibular ramus.

2. Extensions

Four extensions arise from the main body:

• Sublevator extension – beneath the levator labii superioris.

• Melolabial extension – toward the nasolabial region.

• Buccal extension – toward the anterior cheek.

• Pterygoid extension – toward the pterygomandibular region.

Vascular and Neural Relations

• Arterial supply: Facial artery, transverse facial artery, and buccal branches of the maxillary artery (corresponding veins)

• Innervation:

  • Motor: Buccal branches of the facial nerve (CN VII).

  • Sensory: Buccal nerve from the mandibular division of trigeminal nerve (CN V₃).

Functions

• Gliding Pad: Facilitates the movement of muscles of mastication by reducing friction.

• Protective Cushion: Protects deeper muscles and neurovascular structures from mechanical stress and external impact.

• Suckling and Chewing (Infants): Provides structural support to the cheeks during suckling; correlates with the more prominent intermediate lobe in neonates.

• Facial Contour: Maintains midfacial fullness, contributing to youthful appearance.

Developmental and Functional Changes

• Prominent in infants and young children to aid suckling.

• Gradual involution of the intermediate lobe leads to less prominent cheeks in adulthood.

• May atrophy with ageing or malnutrition, accentuating facial hollowness.

Clinical Relevance

• Surgical Applications:

  • Utilized as a pedicled buccal fat pad flap for closure of oroantral and oronasopharyngeal fistulas, palatal defects, and maxillary reconstructive surgery.

• Aesthetic Procedures:

  • Buccal fat pad reduction (bichectomy) for facial slimming; over-resection risks facial gauntness or injury to nearby structures.

• Surgical Precautions:

  • Close relation to parotid duct and facial nerve branches mandates caution during intraoral or facial surgery.

Summary Table