A pedicled buccal fat pad for paranasal volume augmentation in orthognathic surgery: a case report

Nowadays, most patients undergo orthognathic surgery primarily for aesthetic reasons; therefore, achieving facial harmony should be a priority for the surgeon, equal in importance to the final occlusion. Le Fort I advancement and clockwise rotation can partially fill the paranasal deficiency, but at the cost of significantly increasing both the width of the nasal wings and nasal tip projection. In patients with severe maxillary hypoplasia, a hyperprojected nasal tip, and a wide alar base, these movements may be aesthetically counterproductive. Many soft-tissue ancillary procedures have been described to improve and complete orthognathic surgery. The aim of this technical note is to describe a new technique to increase the paranasal volume without worsening nasal tip hyperprojection and alar base width, when a greater maxillary advancement is not possible for occlusal or aesthetic reasons.

We used a buccal fat pad to fill the paranasal region in a patient with a round face and maxillary hypoplasia that could not be advanced as far as we wanted, especially for aesthetic reasons. Evaluation criteria include: photographic analysis, clinical observation and patient satisfaction.

We assessed whether the result of fat transposition was satisfying and clinically and radiologically stable even after 12 months. Our new technique is a good and easy compromise in Class-III patients with a round face for whom a large maxillary advancement could not be performed for dental and nasal reasons.