Buccal Fat Pad Swelling in Neonates and Infants
Immediate Management Approach
For traumatic buccal fat pad herniation in neonates and infants, surgical relocation is the preferred treatment over excision, as it preserves facial contour and function while providing excellent long-term outcomes. 1
Clinical Recognition and Diagnosis
The condition presents as a soft, yellow, pedunculated mass protruding through the buccal mucosa, typically at occlusal level, following trauma to the cheek. 1, 2 Key diagnostic features include:
- History of recent trauma (fall with object in mouth, bite injury, or blunt force to cheek) 1, 3
- Sudden appearance of intraoral mass that was not present before injury 3
- Age range: predominantly 4 months to 12 years, with no gender predilection 1
- Characteristic location: herniation through small mucosal perforation, with mass size disproportionately larger than the perforation 3
- Yellow, lobulated appearance consistent with adipose tissue 2, 3
Critical pitfall: The clinical presentation can mimic intraoral tumors such as lipoblastoma, requiring careful differentiation. 4 If diagnostic uncertainty exists, biopsy showing adipose tissue confirms the diagnosis. 4
Treatment Algorithm
First-Line: Surgical Relocation (Preferred)
Surgical relocation should be performed as the primary treatment when diagnosed early, ideally within days of injury. 1, 3 This approach:
- Preserves the buccal fat pad's anatomical function in facial contour and development 1
- Provides excellent 12-month outcomes without esthetic or functional disturbance 1
- Requires antibiotic coverage to prevent infection during healing 1
- Involves gentle repositioning of herniated fat through the mucosal defect with primary closure 3
Alternative: Surgical Excision
Excision was historically the most common approach (82.9% of reported cases), but this reflects older practice patterns rather than optimal management. 1 Consider excision only when:
- Delayed presentation makes relocation technically difficult 3
- Tissue necrosis has occurred from prolonged herniation 2
- Multiple failed relocation attempts have occurred 1
Conservative Observation
Spontaneous resolution can occur but is rare (2.4% of cases). 1, 4 One documented case showed natural return and engraftment of herniated fat without intervention. 4 However, observation should only be considered for:
- Very small herniations detected immediately after injury 4
- Families declining surgical intervention with close follow-up arranged 4
- High surgical risk patients where intervention poses greater danger 1
Perioperative Management
Anesthesia Considerations
- General anesthesia is required for adequate surgical access and patient cooperation in this age group 2
- Ensure experienced pediatric anesthesia team given young patient age 1
Antibiotic Coverage
- Prophylactic antibiotics should be administered perioperatively to prevent infection of the surgical site 1
- Continue antibiotics postoperatively for 5-7 days to support healing 1
Wound Care
- Primary closure of mucosal defect after fat pad relocation 3
- Soft diet for 1-2 weeks to minimize trauma to healing site 1
- Avoid trauma to surgical area during healing period 3
Follow-Up Protocol
Standard follow-up in the literature ranges only 1 week to 4 months, representing a significant evidence gap. 1 However, the single case with 12-month follow-up after relocation showed:
- No recurrence of herniation 1
- No esthetic defects or facial asymmetry 1
- No functional disturbances in feeding or facial expression 1
Recommended follow-up schedule:
- 1 week post-procedure: assess wound healing and infection 1
- 1 month: evaluate for early recurrence 1
- 3-6 months: assess facial symmetry and function 1
- 12 months: long-term outcome assessment 1
Prevention Counseling
Parents must be educated about injury prevention, as young children frequently fall with objects in their mouths. 4 The suckling activity in infants may encourage herniation following even minor mucosal trauma. 3