Хирургическая анатомия жирового тела щеки человека (обзор литературы)

Цель: проанализировать современные данные о хирургической анатомии жирового тела щеки человека на основе обзора отечественной и зарубежной литературы.
Материалы и методы. Проведён анализ научных публикаций, посвящённых изучению анатомического строения, топографии, функций и клинического применения жирового тела щеки (жирового комка Биша). Рассмотрены данные о макроанатомии, гистотопографических особенностях, вариантной анатомии и возрастных изменениях данной структуры.
Результаты. Установлено, что жировое тело щеки представляет собой специализированную массу жировой ткани, состоящую из трёх независимых долей (передней, промежуточной и задней), каждая из которых имеет собственную капсулу и кровоснабжение. Структура фиксируется шестью связками к различным анатомическим образованиям лицевого черепа. Выявлены противоречивые данные относительно морфометрических параметров, топографических особенностей и функционального значения жирового тела щеки у лиц разного пола и возраста. Показано широкое применение данной структуры в реконструктивной и пластической хирургии для закрытия дефектов полости рта, реконструкции верхней челюсти, лечения анкилоза височно-нижнечелюстного сустава и эстетических операций.
Заключение. Несмотря на активное изучение жирового тела щеки, в литературе сохраняются противоречивые данные о его анатомическом строении, морфометрических характеристиках и функциональном значении. Необходимы дальнейшие комплексные исследования с применением современных морфологических методов для получения целостного представления о хирургической анатомии данной структуры и оптимизации ее клинического применения.

1. Международная анатомическая терминология. Под ред. Л.Л Колесникова. Москва: Медицина. 2003;424.

2. Nelke K, Morawska A, Błaszczyk B, Janeczek M, Pasicka E, Łukaszewski M, et al. Anatomical and Surgical Implications of the Usage of Bichat Fat Pad in Oroantral Communication, Maxillary, Palatal, and Related Surgeries-Narrative Review. J Clin Med. 2023;12(15):4909. PMID: 37568311; PMCID: PMC10419993. https://doi.org/10.3390/jcm12154909

3. Gosain AK, Klein MH, Sudhakar PV, Prost RW. A volumetric analysis of soft-tissue changes in the aging midface using high-resolution MRI: implications for facial rejuvenation. Plast Reconstr Surg. 2005;115(4):1143-52; discussion 1153-5. PMID: 15793457. https://doi.org/10.1097/01.prs.0000156333.57852.2f

4. Marzano UG. Lorenz Heister's "molar gland". Plast Reconstr Surg. 2005;115(5):1389-93. PMID: 15809604. https://doi.org/10.1097/01.prs.0000157014.77871.8d

5. Gaughran GR. Fasciae of the masticator space. Anat Rec. 1957;129(4):383-400. PMID: 13533886. https://doi.org/10.1002/ar.1091290403

6. Yousuf S, Tubbs RS, Wartmann CT, Kapos T, Cohen-Gadol AA, Loukas M. A review of the gross anatomy, functions, pathology, and clinical uses of the buccal fat pad. Surg Radiol Anat. 2010;32(5):427-36. PMID: 19937328. https://doi.org/10.1007/s00276-009-0596-6

7. Dubin B, Jackson IT, Halim A, Triplett WW, Ferreira M. Anatomy of the buccal fat pad and its clinical significance. Plast Reconstr Surg. 1989;83(2):257-64. PMID: 2911625. https://doi.org/10.1097/00006534-198902000-00009

8. Stuzin JM, Baker TJ. Discussion of Anatomy of the Buccal Fat Pad and Its clinical significance by Dubin B, Jackson IT, Halim A, Triplett WW, Ferreira M. Plast Reconstr Surg. 1989;82:263–264.

9. Kahn JL, Wolfram-Gabel R, Bourjat P. Anatomy and imaging of the deep fat of the face. Clin Anat. 2000;13(5):373-82. PMID: 10982997. https://doi.org/10.1002/1098-2353(2000)13:5<373::AID-CA7>3.0.CO;2-W

10. Zhang HM, Yan YP, Qi KM, Wang JQ, Liu ZF. Anatomical structure of the buccal fat pad and its clinical adaptations. Plast Reconstr Surg. 2002;109(7):2509-18; discussion 2519-20. PMID: 12045584. https://doi.org/10.1097/00006534-200206000-00052

11. Favero G, van Noorden CJF, Rezzani R. The Buccal Fat Pad: A Unique Human Anatomical Structure and Rich and Easily Accessible Source of Mesenchymal Stem Cells for Tissue Repair. Bioengineering (Basel). 2024;11(10):968. PMID: 39451344; PMCID: PMC11505344. https://doi.org/10.20340/vmi-rvz.2025.1.PHYS.1

12. Loukas M, Kapos T, Louis RG Jr, Wartman C, Jones A, Hallner B. Gross anatomical, CT and MRI analyses of the buccal fat pad with special emphasis on volumetric variations. Surg Radiol Anat. 2006;28(3):254-60. PMID: 16528468. https://doi.org/10.1007/s00276-006-0092-1

13. Amin MA, Bailey BM, Swinson B, Witherow H. Use of the buccal fat pad in the reconstruction and prosthetic rehabilitation of oncological maxillary defects. Br J Oral Maxillofac Surg. 2005;43(2):148-54. PMID: 15749216. https://doi.org/10.1016/j.bjoms.2004.10.014

14. Nelke K, Morawska A, Błaszczyk B, Janeczek M, Pasicka E, Łukaszewski M, et al Anatomical and Surgical Implications of the Usage of Bichat Fat Pad in Oroantral Communication, Maxillary, Palatal, and Related Surgeries-Narrative Review. J Clin Med. 2023;12(15):4909. PMID: 37568311; PMCID: PMC10419993. https://doi.org/10.3390/jcm12154909

15. Rácz L, Maros TN, Seres-Sturm L. Structural characteristics and functional significance of the buccal fat pad (corpus adiposum buccae). Morphol Embryol (Bucur). 1989;35(2):73-7.

16. Poissonet CM, Burdi AR, Bookstein FL. Growth and development of human adipose tissue during early gestation. Early Hum Dev. 1983;8:1–11. PMID: 6851910. https://doi.org/10.1016/0378-3782(83)90028-2

17. Bagdade JD, Hirsch J. Gestational and dietary influences on the lipid content of the infant buccal fat pad. Proc Soc Exp Biol Med. 1966;122(2):616-9. PMID: 6010136/ https://doi.org/10.3181/00379727-122-31206

18. Ponrartana S, Patil S, Aggabao PC, Pavlova Z, Devaskar SU, Gilsanz V. Brown adipose tissue in the buccal fat pad during infancy. PLoS One. 2014;9(2):e89533. PMID: 24586852; PMCID: PMC3931802. https://doi.org/10.1371/journal.pone.0089533

19. Hamilton G, Smith DL Jr, Bydder M, Nayak KS, Hu HH. MR properties of brown and white adipose tissues. J Magn Reson Imaging. 2011;34(2):468-73. https://doi.org/10.1002/jmri.22623

20. Hu HH, Tovar JP, Pavlova Z, Smith ML, Gilsanz V. Unequivocal identification of brown adipose tissue in a human infant. J Magn Reson Imaging. 2012;35(4):938-42. PMID: 22180228; PMCID: PMC3310283. https://doi.org/10.1002/jmri.23531

21. Chen YI, Cypess AM, Sass CA, Brownell AL, Jokivarsi KT, Kahn CR, Kwong KK. Anatomical and functional assessment of brown adipose tissue by magnetic resonance imaging. Obesity (Silver Spring). 2012;20(7):1519-26. PMID: 22343821; PMCID: PMC4383098. https://doi.org/10.1038/oby.2012.22

22. Egyedi P. Utilization of the buccal fat pad for closure of oro-antral and/or oro-nasal communications. J Maxillofac Surg. 1977;5(4):241-4. PMID: 338848. https://doi.org/10.1016/s0301-0503(77)80117-3

23. Tideman H, Bosanquet A, Scott J. Use of the buccal fat pad as a pedicled graft. J Oral Maxillofac Surg. 1986;44(6):435-40. PMID: 3457926. https://doi.org/10.1016/s0278-2391(86)80007-6

24. Plagge A, Gordon E, Dean W, Boiani R, Cinti S, Peters J, Kelsey G. The imprinted signaling protein XL alpha s is required for postnatal adaptation to feeding. Nat Genet. 2004;36(8):818-26PMID: 15273686. . https://doi.org/10.1038/ng1397

25. Montero JF, de Souza HC, Martins MS, Oliveira MN, Benfatti CA, de Souza Magini R. Versatility and Importance of Bichat's Fat Pad in Dentistry: Case Reports of Its Use in Occlusal Trauma. J Contemp Dent Pract. 2018;19(7):888-894. PMID: 30066696.

26. Chouikh F, Dierks EJ. The Buccal Fat Pad Flap. Oral Maxillofac Surg Clin North Am. 2021;33(2):177-184. PMID: 33541783. https://doi.org/10.1016/j.coms.2020.12.005

27. Surek CC, Kochuba AL, Said SA, Cho KH, Swanson M, Duraes E, et al. External Approach to Buccal Fat Excision in Facelift: Anatomy and Technique. Aesthet Surg J. 2021;41(5):527-534. PMID: 31965150. https://doi.org/10.1093/asj/sjaa015

28. Saralaya S, Desai AK, Ghosh R. Buccal fat pad in cleft palate repair- An institutional experience of 27 cases. Int J Pediatr Otorhinolaryngol. 2020;137:110218. https://doi.org/10.1016/j.ijporl.2020.110218

29. Nozawa A. [Histological observation on the structural feature and blood supply of corpus adiposum baccae]. Kokubyo Gakkai Zasshi. 2002;69(2):128-38. Japanese. https://doi.org/10.5357/koubyou.69.128. PMID: 12136660.

30. Kim CY, Takeshita Y, Kugimoto T, Harada H, Park JS, Tubbs RS, et al. Anatomy of the Buccal Space: Surgical and Radiological Perspectives. J Craniofac Surg. 2024;35(7):1972-1976. PMID: 38885157. https://doi.org/10.1097/SCS.0000000000010411

31. Dean A, Alamillos F, García-López A, Sánchez J, Peñalba M. The buccal fat pad flap in oral reconstruction. Head Neck. 2001;23(5):383-8. PMID: 11295812. https://doi.org/10.1002/hed.1048

32. Fan L, Chen G, Zhao S, Hu J. Clinical application and histological observation of pedicled buccal fat pad grafting. Chin Med J (Engl). 2002;115(10):1556-9. PMID: 12490110.

33. Shibahara T, Watanabe Y, Yamaguchi S, Noma H, Yamane GY, Abe S, et al. Use of the buccal fat pad as a pedicle graft. Bull Tokyo Dent Coll. 1996;37(4):161-5. PMID: 9151571

34. Jackson IT. Anatomy of the Buccal Fat Pad and Its Clinical Significance. Plastic and Reconstructive Surgery. 1999;103(7):2059-2060.

35. Rattan V. A simple technique for use of buccal pad of fat in temporomandibular joint reconstruction. J Oral Maxillofac Surg. 2006;64(9):1447-51. PMID: 16916685. https://doi.org/10.1016/j.joms.2005.07.017

36. Consorti G, Catarzi L, Valassina D, Balercia P. Palatal reconstruction with tunnellized Bichat fat pad flap after tumor resection. Minerva Dent Oral Sci. 2022;71(3):168-173. https://doi.org/10.23736/S2724-6329.21.04459-9

37. Ibikunle AA, James O, Adeyemo WL. Buccal Fat Pad for Interpositional Arthroplasty in Temporomandibular Joint Ankylosis. J Maxillofac Oral Surg. 2019;18(3):382-387. PMID: 31371878; PMCID: PMC6639516. https://doi.org/10.1007/s12663-018-1130-3

38. Ikekhuamen EA, Gambo A, Fomete B, Agbonifo D, Yusuf O. Buccal Fat Pad Flap, an Option for Surgical Reconstruction of Orbital Floor Defect: A Case Report. J West Afr Coll Surg. 2022;12(1):95-99. PMID: 36203927; PMCID: PMC9531734. https://doi.org/10.4103/jwas.jwas_89_22

39. Jose A, Rawat A, Nagori SA, Arya S, Shukla D. Outcomes of sequestrectomy and buccal fat pad reconstruction in the management of medicationrelated osteonecrosis of the jaws. Oral Maxillofac Surg. 2022;26(1):147-153. PMID: 34028628. https://doi.org/10.1007/s10006-021-00973-9

40. Kim MK, Han W, Kim SG. The use of the buccal fat pad flap for oral reconstruction. Maxillofac Plast Reconstr Surg. 2017;39(1):5. PMID: 28286743; PMCID: PMC5325802. https://doi.org/10.1186/s40902-017-0105-5

41. Daif ET. Long-Term Effectiveness of the Pedicled Buccal Fat Pad in the Closure of a Large Oroantral Fistula. J Oral Maxillofac Surg. 2016;74(9):1718-22. PMID: 27265647. https://doi.org/10.1016/j.joms.2016.04.033

42. Nezafati S, Vafaii A, Ghojazadeh M. Comparison of pedicled buccal fat pad flap with buccal flap for closure of oro-antral communication. Int J Oral Maxillofac Surg. 2012;41(5):624-8 PMID: 22192386. . https://doi.org/10.1016/j.ijom.2011.11.011

43. Zhang Q, Li L, Tan W, Chen L, Gao N, Bao C. Application of unilateral pedicled buccal fat pad for nasal membrane closure in the bilateral complete cleft palate. J Oral Maxillofac Surg. 2010;68(8):2029-32. PMID: 20542618. https://doi.org/10.1016/j.joms.2010.02.042

44. Nabil S, Ramli R. The use of buccal fat pad flap in the treatment of osteoradionecrosis. Int J Oral Maxillofac Surg. 2012;41(11):1422-6. PMID: 22406235. https://doi.org/10.1016/j.ijom.2012.04.001

45. Rotaru H, Kim MK, Kim SG, Park YW. Pedicled buccal fat pad flap as a reliable surgical strategy for the treatment of medication-related osteonecrosis of the jaw. J Oral Maxillofac Surg. 2015;73(3):437-42. PMID: 25544302. https://doi.org/10.1016/j.joms.2014.09.023