Buccal Fat Pad Herniation, Repositioning Versus Excision: A New Algorithm of Treatment

Traumatic herniation of the buccal fat pad can be treated with repositioning or excision. This report describes a case of a child with traumatic herniation of the buccal fat pad treated with excision. A comprehensive review of the literature was performed with the objective of establishing treatment criteria for the decision-making involved in choosing between repositioning versus excision.

A systematic review of the literature was performed through searches of PubMed, Ovid, Elsevier, Cochrane, ResearchGate and Google Scholar for reports published from 1968 through May 2021. The search keywords used were traumatic herniation of the buccal fat pad, buccal fat pad herniation, traumatic pseudolipoma, and traumatic lipoma. We included only those studies that included patients with intraoral buccal fat pad herniation.

We found and included 39 articles (44 patients). Time since trauma, size of the fat pad herniated, and presence of necrosis were the most important characteristics considered for treatment decision; on the basis of these factors, we created a treatment algorithm. We present a case report of a 2-year-old boy diagnosed with traumatic herniation of buccal fat pad and, according to our algorithm, the appropriate treatment was to perform excision. A follow-up examination at 11 months showed no complications.

Because traumatic herniation of buccal fat pad is very rare, this algorithm can be an easy and effective tool to guide decision-making when choosing between repositioning versus excision.