BFP VMs show reproducible anatomical extension patterns, most commonly with spread beyond the buccal component into adjacent deep facial spaces, and recognition of these patterns may facilitate imaging assessment, treatment planning, and staged correction of facial asymmetry.
Facial swelling or asymmetry was the predominant presenting manifestation of venous malformations involving the buccal fat pad.
The majority of buccal fat pad venous malformations extended beyond the buccal component into adjacent deep facial spaces.
An extension-based classification system categorized buccal fat pad venous malformations into three types.
Image-guided sclerotherapy was the initial treatment in all patients, with additional surgical procedures performed in a subset.
Treatment resulted in complete or partial resolution of lesion-related symptoms in all patients.
Facial symmetry was restored or improved in all patients following staged treatment.
Retrospective reinterpretation of previously reported cases revealed similar anatomical extension patterns to those observed in the study cohort.
This research suggests that venous malformations (abnormal tangles of veins) involving the buccal fat pad — a discrete pocket of fat in the cheek — are more anatomically complex than previously recognized. In a group of 22 patients treated over a 10-year period, nearly 70% of these lesions had spread beyond the cheek fat itself into deeper regions of the face, particularly spaces near the jaw and the base of the skull. The study introduces a classification system that groups these lesions into three types based on how far they have spread, which could help doctors better plan treatment before operating. All patients were initially treated with sclerotherapy — a procedure where a chemical agent is injected under image guidance to shrink abnormal blood vessels — and many also needed follow-up procedures to reshape soft tissue or bone. Encouragingly, every patient experienced at least some improvement: symptoms fully resolved in about three-quarters of patients, and all patients achieved at least partial restoration of facial symmetry. A review of 12 previously published cases found the same patterns of spread, supporting the idea that these lesions follow predictable anatomical routes. This research suggests that recognizing the typical ways these lesions spread through the face could improve how radiologists interpret scans and how surgeons plan staged treatments, especially for patients with significant facial asymmetry. By understanding that the lesion often extends into deep facial spaces, clinicians may be better prepared to achieve complete treatment and avoid underestimating the full extent of the problem.
Zhang Y, Liang J, Liu M, Liu M, Liu Y. (2026). Venous malformations involving the buccal fat pad: anatomical extension patterns and management implications.. Frontiers in neurology. https://doi.org/10.3389/fneur.2026.1931652