Buccinator Research Articles

Modified Buccal Myomucosal Flap Closure of Large Anterior Palatal Oronasal Fistulas.

Large oronasal palatal fistulas can be challenging to reconstruct. The authors present a modified buccal myomucosal flap repair technique and review intermediate-term outcomes. In this technique, large anterior palatal fistulas are closed in two layers. First, apposing nasal turnover flaps of vomer mucosa medially and nasal wall mucosa laterally are approximated. Second, a posteriorly based buccal flap incorporating full-thickness buccinator muscle and overlying mucosa is transposed with interposition of the flap in the retromolar trigone and lateral palate to preserve dental occlusion. Consecutive patient cases performed in low-resource settings were reviewed and outcomes reported. Among eight subjects aged 3 to 22 years, with average defect size of 2.5 cm2 (range, 0.8 to 3.5 cm2), the flap was viable in all cases and required revision or pedicle division in only two patients (25 percent); all patients showed symptom improvement. The modified buccal myomucosal flap shows promising intermediate-term results as a single-stage reconstruction suitable to a wide patient age range, low airway/anesthetic risk, reliable functional outcomes, and low comorbidity.

Buccinator synkinesis treated by botulinum toxin in facial palsy and hemifacial spasms

To assess botulinum toxin treatment for buccinator muscle synkinesis including: how often the synkinesis was troublesome; who benefitted and how from the treatment; and what were the adverse effects, ideal dosage, and injection site. Facial palsy (FP) patients and patients with hemifacial spasms who were attending for multiple site botulinum-toxin treatment for facial sequelae were assessed for buccinator synkinesis. The study group comprises those experiencing buccinator synkinesis with associated bothering symptoms who were willing to try injection also to the buccinator muscle. During 9/2017-12/2019, 126 different patients with facial sequelae were treated with multiple-site botulin-toxin injections by the author. Of them, 83 (66%) received injection also for buccinator synkinesis and 66/82 (80%) wanted to continue with the buccinator injections. The most remarkable results were seen with FP patients biting the mucus membrane of their cheek: usually the biting ceased totally. Patients with powerful hemifacial cheek spasms also experienced cessation of the spasms, contrasting any previous treatments. Adverse effects were mostly mild: slight weakness of the corner of the mouth or additional leakage of saliva or liquids. Only a few patients experienced more pronounced adverse effects. The most posterior contracting part of the buccinator muscle proved to be the best site for the injection. Buccinator synkinesis was very common and its treatment gave many patients additional relief from facial sequelae symptoms. Professionals treating patients with synkinesis and hemifacial spasms should add well-tolerated buccinator injections to their repertoire of injection sites.

Management of Traumatic Herniation of Buccal Fat Pad in a 22-month-old Child: A Case Report

The buccal fat pad is an encapsulated mass located within the buccal facial spaces. It is relatively large in neonate and infants. A tiny perforation on buccal mucosa, fascia or buccinator muscle can lead to the herniation of buccal fat pad in young children. Trauma is the most common etiology. Such situation demands careful examination of oral cavity and thorough history taking to avoid any misdiagnosis. This paper reports a clinical presentation and management of herniation of buccal fat pad on a 22-month-old-girl following trauma to her left cheek region with sugarcane.

Myomucosal island flap of the buccinator Muscle: An anatomical study

IntroductionDespite its ease of dissection and accessibility, the buccinator muscle has received little attention in the surgical literature as an island flap. This study aimed to clarify the detailed anatomy of the buccinator muscle and the important related structures for planning to use it as a myomucosal island flap. Materials and methodsThe study was carried out on 30 hemifaces from 15 adult cadavers (12 males and 3 females). The cadavers were injected with red latex through the external carotid artery. The buccinator muscle was carefully dissected, and the vessels and nerves reaching its surface, and their origins and points of entry into the muscle were observed. The facial vessels were separated from the superior and inferior labial as well as from the angular branches. Then, the buccinator muscle with its vascular pedicles was delivered alone. The extent of the pedicle was then evaluated for its potential reach. The distance of the vessels and nerves related to the muscle together with the parotid duct was measured in relation to two reference points, the labial commissure (LC) and the upper point of the zygomatic arch (Z) just in front of the auricle, and the dimensions of the muscle were estimated. ResultsThe present study showed that the anterior part of the muscle had an arterial supply from the facial artery and its venous blood drained into the facial vein. The posterior part of the muscle was supplied by the buccal and posterior superior alveolar arteries, and its venous blood drained into the pterygoid venous plexus. The nerve supply of the muscle was through the lower ramus of the buccal branch of the facial nerve. The mandibular rami of the facial nerve were found to lie superficial to the facial vein, but interlacing with the facial artery (superficial, deep, or superficial and deep). From the valuable measurements obtained, the facial artery crossed the reference line (LC-Z) at the meeting of the medial ¼ with the lateral ¾ of that line, and the facial vein was 0.8 cm posterior to the artery. It was also found that the buccinator island pedicle after its harvest reached the upper ends of the trachea and esophagus. In addition, rotation of the pedicle downward and forward until 180° did not form kinks of the pedicle. ConclusionsAccording to the present study, the buccinator island flap is safe, reliable, and provides mucosa; however, it has no sensation or motility.

Sialendoscopy-assisted transoral approach for parotid gland lithiasis.

Although lithiasis represents more than 60% of all cases of salivary gland obstruction, only 20% occurs in the Stensen´s duct. Nonetheless, the potential complications related to parotid gland surgery due to facial nerve injury, makes the development of minimally invasive techniques highly relevant. A pilot study was conducted to assess results of patients treated by sialendoscopy-assisted trans-oral approach to treat Stensen´s duct lithiasis. Eight patients were included; all of them operated satisfactorily. Six of them were male, and 2 were female. The mean size of the stones was 9.6mm (Min: 6mm/Max: 16mm). Regarding to lithiasis location: it was anterior to the masseter line in the distal third of the Stensen's duct in seven patients and in another patient was immediately below the buccinator muscle. During the follow-up, all patients presented a healthy functioning of the gland after the compressive massage. Regarding complications, one patient presented a Stensen's duct stenosis, which required reintervention. The transoral Stensen´s duct approach represents a safe technique for lithiasis bigger than 3mm in the distal portion of the Stensen´s duct, anterior to the Masseter Muscle line and when other minimal invasive techniques fail.

Facial Muscle Activity Patterns in Clarinet Players: A Key to Understanding Facial Muscle Physiology and Dysfunction in Musicians.

Facial muscle activity is crucial to controlling musical performance in wind instrument playing. Facial muscle dysfunctions are common in wind instrument players, dramatically affecting their professional musical activity and potentially leading to disabling symptoms.The aim of this pilot study on a cohort of healthy clarinetists was to use surface electromyography to identify the facial muscle activity patterns involved in stabilizing the mouthpiece, controlling emission and articulation during musical tasks in physiological conditions, also comparing muscle activity between less and more experienced clarinetists (students vs postgraduates/professionals). Surface electromyographic measures of the sternocleidomastoid, masseter, mentalis, mylohyoid and buccinator muscles were obtained from eight healthy clarinet players (four students and four postgraduates/professionals) performing two standardized musical tasks. Overall, mean IEMG activity was significantly lower for the sternocleidomastoid than for the other muscles (P = .000), and for the mouthpiece-stabilizing muscles (masseter and mentalis) than for those directly involved in controlling emission and articulation (buccinator and mylohyoid muscles) (P = .000).Regardless of the musical task, the mean IEMG values were significantly higher in the students for the masseter (P = .0007), buccinator (P = .0001) and mylohyoid (0.000), while they were significantly higher in the postgraduates/professionals for the mentalis (P = .000). No significant differences emerged between the two groups for the sternocleidomastoid (P = .207). These preliminary data reflect a significantly higher overall facial muscle activity in the less-experienced group, potentially resulting in an overload, whereas the more expert players had more optimized muscle activity patterns.

Morphological magnetic resonance imaging study of oral submucosal tissue and buccinator muscle dynamics in the posterior dentition: A clinical study

Statement of problemThe relationship between the buccal mucosa-tongue side wall contact points and at what ratio the submucosal tissue (ST) and buccinator muscle (BUC) change during function are unclear. PurposeThe purpose of this clinical study was to clarify the space and dynamics of the ST and BUC in complete denture wearers by using magnetic resonance imaging and to investigate how denture base shape affects space sealing and the relationship between the ST and BUC. Material and methodsEight edentulous participants wearing maxillary and mandibular complete dentures were enrolled. Wax was added to the buccal border of the dentures, and axial and coronal magnetic resonance imaging scans were made during mandibular rest (MR) to observe the relationship of the buccal mucosa and tongue above the retromolar pads. In addition, on axial images, the thicknesses of the ST and BUC were measured at 3 sites: second molar center, second molar distal (SMD), and retromolar pad center (RPC). Coronal images were made during MR, partial mouth opening, and midmouth opening (MMo). At second molar center, SMD, and RPC, the thicknesses of the ST and BUC were measured at the maxillary buccinator attachment region (point A), the mandibular buccinator attachment region (point B), and the median point between A and B (point M). ResultsDuring MR, contact sealing of the buccal mucosa and tongue on the RPC was noted in 81% of participants. After expanding the denture base with wax, contact was lost in 86% of participants. The ST and BUC thicknesses on the RPC decreased significantly with the addition of wax. During MR, the ST became significantly thicker the further posteriorly it was located. The ST was significantly thicker at point M than at point A for all sections, regardless of mouth opening. The ST and BUC thicknesses in SMD and RPC were significantly thicker at point M than at point B during MR and MMo. The differences of the ST and BUC thicknesses depending on the opening amount were observed only at the point M. In the RPC, the thickness of the ST and BUC decreased significantly as the opening amount increased (ST thickness between MR and partial mouth opening, MR, and MMo: P=.007, P=.001, BUC: P=.018, P=.001, respectively) ConclusionsThe thickness of the ST and BUC differed depending on the site. During mouth opening, these changes in thickness at each site are proportional to the differences in ST and BUC thickness.

Identification of the Preferred Interventional Approach to Trigeminal Ganglion Using Three-Dimensional Reconstruction Stereoscopic Model

Trigeminal ganglion injection is a common procedure for many facial pain syndromes, including trigeminal neuralgia. The procedure is usually done under fluoroscopy guidance to target at the foramen ovale where lies the trigeminal ganglion and the mandibular branch of trigeminal nerve exits. In this project, Amira® software was used to create 3D structures that can be visualized stereoscopically and involve the structures to study the procedure pathway. The detailed anatomical structures include the skin, skull, external and internal pterygoid muscle, masseter muscle, buccinator muscle, external carotidartery and its branches, internal carotid artery and its branches, vertebral artery, trigeminal ganglion and its branches, internal jugular vein, and parotid gland were created. The structures’ relationships and potential complications are described. The 3D model is used to guide and educate students about safe procedure pathways and may potentially be used to evaluate and modify procedures scientifically.

Muscle Progenitors Derived from Extraocular Muscles Express Higher Levels of Neurotrophins and their Receptors than other Cranial and Limb Muscles.

Extraocular muscles (EOMs) show resistance to muscle dystrophies and sarcopenia. It has been recently demonstrated that they are endowed with different types of myogenic cells, all of which present an outstanding regenerative potential. Neurotrophins are important modulators of myogenic regeneration and act promoting myoblast proliferation, enhancing myogenic fusion rates and protecting myotubes from inflammatory stimuli. Here, we adapted the pre-plate cell isolation technique to obtain myogenic progenitors from the rat EOMs, and quantified their in vitro expression of neurotrophins and their receptors by RT–qPCR and immunohistochemistry, respectively. The results were compared with the expression on progenitors isolated from buccinator, tongue and limb muscles. Our quantitative analysis of brain-derived neurotrophic factor (BDNF), nerve growth factor (NGF) and neurotrophin-3 (NT-3) transcripts showed, for the first time, that EOMs-derived cells express more of these factors and that they expressed TrkA, but not TrkB and TrkC receptors. On the contrary, the immunofluorescence analysis demonstrated high expression of p75NTR on all myogenic progenitors, with the EOMs-derived cells showing higher expression. Taken together, these results suggest that the intrinsic trophic differences between EOMs-derived myogenic progenitors and their counterparts from other muscles could explain why those cells show higher proliferative and fusion rates, as well as better regenerative properties.

Design and validation of a closed-loop, motor-activated auricular vagus nerve stimulation (MAAVNS) system for neurorehabilitation

BackgroundStudies have found that pairing vagus nerve stimulation (VNS) with motor activity accelerates cortical reorganization. This synchronous pairing may enhance motor recovery. ObjectiveTo develop and validate a motor-activated auricular vagus nerve stimulation (MAAVNS) system as a potential neurorehabilitation tool. MethodsWe created MAAVNS and validated its function as part of an ongoing clinical trial investigating whether taVNS-paired rehabilitation enhances oromotor learning. We compared 3 different MAAVNS EMG electrode configurations in 3 neonates. The active lead was placed over the buccinator muscle. Reference lead placements were orbital, temporal or frontal. ResultsThe frontal reference lead produced the highest sensitivity (0.87 ± 0.07 (n = 8)) and specificity (0.64 ± 0.13 (n = 8)). Oral sucking reliably triggers MAAVNS stimulation with high confidence. ConclusionEMG electrodes placed on target orofacial muscles can effectively trigger taVNS stimuli in infants in a closed loop fashion.

An Intraoperative Salvage After Transection of the Greater Palatine Artery During Cleft Palate Repair: A Case for Buccal Fat and Buccal Myomucosal Flaps

Recently, several adjunctive procedures have gained traction to aid cleft surgeons in repairing especially challenging palatal clefts. Buccal fat flaps and buccal myomucosal flaps have demonstrated particular utility in reinforcing thin palatal flaps or tissue deficits. Although their use has not been widely accepted, they may be particularly helpful in the setting of significant scarring or vascular compromise. Here the authors describe the case of an intraoperative salvage using bilateral buccal fat flaps and a right buccal myomucosal flap after transection of the right Greater Palatine artery (GPA) during palatoplasty on a 14-month old female with Pierre Robin Sequence and a wide Veau II cleft palate. For this operative salvage, bilateral buccal fat flaps were used to reinforce the hard-soft palate junction and a 4 cm × 2 cm flap of the right-sided buccal mucosa and buccinator muscle was inset along the majority of the right-sided soft and posterior hard palate. At 2 years follow-up, the patient had no significant complications and was doing well with healthy-appearing palatal tissue and age-appropriate speech.

Cheek Dimpleplasty: A New Classification of Described Procedures

Cheek dimpleplasty has become a popular request amongst patients requesting cosmetic surgery. Since the first reported dimpleplasty in 1962, there have been many reported procedures in the literature for cheek dimple creation. Some of the procedures described by various authors as “novel” are actually similar if not identical to existing procedures. This study reviews the different procedures of cheek dimple creation and provides the first ever systematic classification for these techniques. EMBASE, Cochrane library, Ovid medicine, and PubMed databases were searched from its inception to June of 2019. We included all studies describing the surgical creation of cheek dimples. The studies were reviewed, and the different procedures were cataloged. We then proposed a new classification system for these procedures based on their common characteristics. The study included 12 articles published in the English language that provided a descriptive procedure for cheek dimple creation. We classified the procedures into 3 broad categories and subcategories. Type 1 procedures are nonexcisional myocutaneous dimpleplasties. In these procedures, the buccinator muscle is not excised. In type 1A, the suture used to create the adhesion traverses the epidermis. In type 1B, the suture does not traverse the epidermis, rather, the suture travels up into the dermis and returned back to the mucosa. Type 2 procedures are excisional dimpleplasties. In these procedures, the buccinator muscle is excised with (open) or without (closed) the excision of the mucosa. Type 3 procedures are incisional dimpleplasty. In these procedures, the muscle is incised and fixed to the dermis. Each of these groups of procedures has potential unique advantages and disadvantages. There are multiple procedures reported in the English language literature for the creation of cheek dimples. Most of the procedures are based on similar concept with minor variations. Our classification system, the Opoku-Simone Classification, will help facilitate communication when describing the different configurations of these procedures. Procedure within each group has similar potential advantages and disadvantages.

Buccinator muscle repositioning: A rare case report, short discussion, and literature review

Anatomical abnormalities are commonly associated with many problems. Among all anomalies, one is crestal attachment of the frenum or muscle on the alveolar process. Crestal attachment of the buccinator muscle is a rare phenomenon. It may cause various problems in routine oral exercises or restore the edentulous area. The present case report is a case of abnormal buccinator muscle attachment, which was relocated apically by surgical means using an acrylic stent. The healing was uneventful, and significant apical repositioning was observed. The area was then considered for implant placement. An implant was placed, and the long-term results were assured because the patient could maintain oral hygiene well after the muscle repositioning.

Schistosoma mansoni granulomas in the skeletal striated muscles in the murine model of neuroschistosomiasis: histological findings.

Schistosomiasis mansoni presents many clinical manifestations during migration of schistosomes in their hosts, including diarrhea, hepatomegaly, splenomegaly, liver abscesses, skinlesions, brain tumors and myeloradiculopathy. No lesions have been reported in skeletal striated muscles due to schistosomiasis mansoni in the literature. This short communication reports the histopathological findings on skeletal musculature in a murine model of neuroeschistosomiasis mansoni. Lesions were found in the tongue, masseter muscle, buccinator muscle, digastric muscle and temporalis muscle. Worm recovery was carried out to confirm the infection. We describe here, for the first time in the literature, injuries in the skeletal musculature due to Schistosoma mansoni nfection.

PLEOMORPHIC ADENOMA OCCUPYING THE INFRATEMPORAL SPACE: A CASE REPORT

Pleomorphic adenoma is the most common benign neoplasm of salivary glands, representing about 33% to 43% of tumors of the minor salivary gland. The palate is the most frequent intraoral site followed by the upper lip and the buccal mucosa. This report describes the development of pleomorphic adenoma in the infratemporal space in a 72-year-old woman. The lesion presented as a submucosal nodule, palpable deep in the left buccal mucosa. The computed tomography revealed a lobed hypodense formation partially obliterating the fat planes between the masseter and buccinator muscles. Surgical excision of the lesion was performed with histopathologic report of pleomorphic adenoma, and the patient is being followed up for 5 months with no signs of recurrence. It is important to note the unusual location and the importance of investigation and diagnostic elucidation for the correct therapeutic approach.

Do subjects with forced lip closure have different perioral and jaw muscles activity?

ABSTRACT Objective: To evaluate the activity of mentalis (MN), buccinator (BC), and suprahyoid (SH) muscles among participants with different lip competence.. Methods: Sixty-three participants were classified clinically and assigned to the following groups of 21 each: 1) competent lips (competent), 2) incompetent lips (incompetent), or 3) forced lip closure (forced). Activity was recorded at rest, swallowing, speaking, reciprocal compression of the lips, and chewing. Results: MN activity in incompetent was significantly higher than competent at rest, and it was significantly higher in incompetent and forced when compared with competent during swallowing (p< .05). No differences among incompetent and forced were observed (p> .05). During speaking, reciprocal compression of the lips, and chewing, MN activity did not show significant differences among groups. BC and SH activity did not show significant differences (p> .05). Conclusion: MN activity during swallowing can be considered a relevant biomarker to differentiate between forced and competent participants.

Cheek Dimpleplasty: A Review of the Literature

Dimpleplasty is the surgical creation of dimples on the face for aesthetic purposes. Dimples have been associated with a sign of beauty and even good fortune in some cultures and have also found themselves in Western cultures. Since the first described procedure of cheek dimple creation in 1962, there have been multiple studies on the topic. The aim of this article is to review the literature on the anatomy, creation, postoperative care, and complications associated with cheek dimpleplasty. The authors performed a literature review that focused on cheek dimpleplasty. EMBASE, Cochrane Library, Ovid Medicine, MEDLINE, Google Scholar, and PubMed databases were searched from its inception to July 2019. Peer-reviewed articles published in the English language were included. Our search in the various databases yielded multiple publications. There were different described techniques published on the determination of the ideal site for a cheek dimple. There were also multiple procedures described for the creation of cheek dimples. The basic tenet of cheek dimple creation is to create an adhesion between the dermis and buccinator muscle to create a dynamic dimple which is present on facial animation. Multiple procedures have been reported with few reported complications. Patient satisfaction is dependent on appropriate determination of the site and morphology of the dimple. Most of the complications associated with cheek dimple creation are minor, easily managed, and avoided by understanding the regional anatomy and attention to meticulous surgical technique.

A new treatment for lingual nerve injury: an anatomical feasibility study for using a buccal nerve pedicle graft.

Lingual nerve (LN) palsy is a serious complication in dentistry and repaired by direct suture or a free graft technique. To our knowledge, there has been no study using a (long) buccal nerve (BN) graft as a donor for LN repair. Therefore, we aimed to clarify the location of the BN and investigate if it is feasible to reroute the BN to the LN. Twenty-four sides from 12 fresh-frozen Caucasian cadaveric heads were used in this study. The mean age at death was 73.9 ± 13.4years. The LN was dissected on the floor of the oral cavity medial to the third molar tooth. Next, the mucosa with the buccinator muscle, pterygomandibular raphe, and superior pharyngeal constrictor muscle on the retromolar area was retracted anteriorly to widen the pathway of the LN. Finally, the BN was cut and transposed to the LN through this widened pathway to its feasibility. The mean diameter of the BN and vertical distance from the horizontal part of the retromolar trigone to the BN was 1.47 ± 0.32mm and 18.53 ± 6.21mm, respectively. On all sides, the BN was able to be transposed to the LN without tension. Such a technique might be used for the patients with LN injury and who have lost sensation of the tongue.

Buccal Mucosa Grafts for Reconstruction in Patients With Female Genital Mutilation

AIM: Reconstruction after female genital mutilation is a relatively new concept in the United States aimed to improve pain and sexual function and to restore a normal physical appearance. The buccal mucosa has been described as a donor-site option for reconstruction of eyelids, cheeks, larynx, urethra, and more recently the vagina. Here we present the novel use of buccal mucosal grafts in the reconstruction of external female genitalia after female genital mutilation. METHODS: 1. Mouth is irrigated with Peridex solution and throat pack is placed. 2. Rectangular piece of thin buccal mucosa is harvested using a #15 blade with care to avoid important structures such as buccal fat pads, buccinator muscle, and Stensen’s duct. Incisions are closed in a single running layer with 4-0 chromic suture. 3. Anterior abdomen fat harvesting is performed using standard Coleman technique. Fat is processed via Telfa rolling on back table. 4. Clitoral scar is incised or excised with careful attention to avoid injury to deeper nerves. 5. A flap harvested from the superior aspect of clitoral skin is rotated inferiorly to cover the superior aspect of the clitoral hood. The remainder of the hood is resurfaced using shaped portions of the buccal mucosa sutured with 4-0 chromic. 6. Flaps from the labia majora are rotated laterally and imbricated to the periosteum with interrupted 4-0 chromic. Medial flaps designed to become the new labia minora are subsequently covered with buccal mucosal grafts on their lateral aspects. 7. Buccal mucosal grafts were dressed with xeroform and antibiotic bolsters. 8. Fat subsequently grafted into bilateral labia majora inferiorly and superiorly into the vulvar region to encourage regeneration of the surgical site. RESULTS: The authors have observed excellent cosmetic outcomes at 6 months postoperatively with well-incorporated tissue. Patients report significantly improved functional outcomes with postoperative clitoral retraining therapy. CONCLUSIONS: Benefits of using the buccal mucosa as a donor site are similar to those reported previously. Namely, these include an inconspicuous donor site scar, primary closure of the donor site, and a decreased need for local tissue rearrangement and distortion of anatomy due to a distant donor site.1,2 As with any new technique, further investigation is needed to examine the long-term functional and cosmetic outcomes, including patient satisfaction and sexual function. Exposure of this technique to plastic surgeons will enable the therapeutic benefits to this greatly underserved population. REFERENCES: 1. Cohen SD, Armenakas NA, Light DM, et al. Single-surgeon experience of 87 buccal mucosal graft harvests. Plast Reconstr Surg. 2012;130:101–104. 2. Simman R, Jackson IT, Andrus L. Prefabricated buccal mucosa-lined flap in an animal model that could be used for vaginal reconstruction. Plast Reconstr Surg. 2002;109:1044–1049.

Traumatic Herniation of the Buccal Fat Pad

Buccal Fat Pad is an encapsulated mass of adipose tissue located within the buccal facial spaces, between the buccinator and masseter muscles. Intraoral traumatic herniation of Buccal Fat Pad, often seen in young children, has been reported as a rare case. In this report, we present a case of traumatic Buccal Fat Pad herniation which at first was misdiagnosed as a malignant tumor.