Traumatic herniation of the buccal fat pad

Resident: Tyler Roberts
Article: Traumatic herniation of the buccal fat pad
Author: Horie. et al
Journal: Pediatric Dentistry
Volume # 23:3, pages: 249 - 251
Year: 2001
Major topic: Traumatic herniation of the buccal fat pad
Type of article: case review
Purpose: To diagnose and treat this rare truamatic lesion found most commonly in children
Kep pts/findings

The buccal fat pad consist of 4 segments: the ptergoid, buccal, superficial and deep temporal areas. It lies wedged between the masseter and the buccinator. It extends on one end from the anterior region of the masseter through to the retromolar region of the mandible. Up until the year 2000, only 31 cases of traumatic herniation of the buccal fat pad has ever been reported.

Case 1

A 10 month old reportedly fell down while holding chopsticks in his mouth. The chopsticks did not break and minimal bleeding was noted at the time of injury. On examination a laceration was found present on his right buccal mucosa, inferior and distal to the parotid papilla. From the laceration a reddish-yellow soft pedunculated mass measuring 1.0 x .5 x.5 cm was protruding. The working diagnoses was given. The treatment included irrigating and reapproximating the margins and placing 4-0 nylong sutures while under local anesthesia. An antibiotic was given for four days and in two weeks the lesion had completely healed.

Case 2
A 1 year 9 month old had fallen while holding her toothbrush in the mouth. The tooth brush was not broken and minimal bleeding was present. The following morning a large mass extended from the right buccal mucosa into the oral cavity. The pedunculated mass appeared to be reddish brown in color with the dimension of 1.5 x 1.0 x 1.0 cm. and located just inferior to the parotic papilla. The working diagnosis was given. Three days later the mass was excised at the hospital under general anesthesia. The patient recieved. 4-0 nylon sutures and was placed on antibiotics for 5 days. One month later everything appeared to be healed with no cosmetic defects.

summary of conclusions:
Almost all cases of buccal herniation of the fat pad have been due to a traumatic injury. It most frequently occurs in infants and small children under the age of 4. The site of the lesion is almost always along the oclussal table near the parotid papilla. Histologically this lesion is not capsulated and composed of mature adipose tissue. Treatment includes excision or reaprroximation of the pad depending on size. No history of recurrence has been reported after treatment.