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Laryngoscope. 2019 Dec 26. doi: 10.1002/lary.28487. [Epub ahead of print]

Does 3D volumetric analysis predict the reach of endoscopically harvested buccal fat pad flap.

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Department of Otolaryngology-Head and Neck Surgery, National University of Singapore, Singapore.
the Department of Otolaryngology-Head and Neck Surgery, Wexner Medical Center at The Ohio State University, Columbus, Ohio.
the Department of Neurosurgery, Wexner Medical Center at The Ohio State University, Columbus, Ohio.
Department of Otolaryngology-Head & Neck Surgery, Southern Illinois University, Springfield, Illinois, U.S.A.



To determine if the volume of buccal fat, ascertained by computed tomography (CT) scanning, would correspond to surface area and reach (length and width) of the flap intraoperatively to aid in the reconstruction of selected skull base defects.


Cadaveric study of five specimens, 10 sides. Methods CT imaging and evaluation using the Osirix 9 software (Pixmeo; Bernex, Switzerland). of cadaveric heads to calculate the volume of the buccal fat bilaterally. The flap was then harvested endoscopically. Measurements were taken. Two heads were also dissected via a transfacial approach.


The volume of the buccal fat pad (BFP) as well as the maximum length and width of the endoscopically harvested flap were documented. There was a positive correlation shown between the calculated volume of the BFP based on CT imaging and the dissected length and width of the flap (Pearson correlation, r = 0.83 and r = 0.80, respectively). The transfacial dissection demonstrated the lobes of the BFP well, showing that most of the endoscopic mobilization of the BFP was limited to the posterior lobe, in particular to the temporalis and pterygoid components, with minimal displacement of the superficial components. This minimized the risk of visibly hollowing the buccal fullness.


Preoperative calculation of the CT-based volume of the BFP correlates positively with the intraoperative maximum reach of the flap for both length and width. Whereas the volume may be lower in some instances, the BFP would still have adequate reach to provide coverage for the lower and mid-clival region in most patients.


NA. Laryngoscope, 2019.


buccal fat pad; pedicle flap; reconstruction; rhinology); skull base (head and neck


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