Venous malformations involving the buccal fat pad: anatomical extension patterns and management implications.

BACKGROUND: Venous malformations (VMs) involving the buccal fat pad (BFP) are uncommon lesions that may cause facial swelling and contour deformity. Although vascular malformations represent the most common pathology affecting the BFP, their anatomical extent, extension patterns, and implications for treatment planning remain poorly defined. This study assessed the imaging features and anatomical extension patterns of BFP VMs and summarized corresponding staged treatment strategies. METHODS: Consecutive patients with VMs involving the BFP treated at a tertiary referral center between 2015 and 2025 were retrospectively reviewed. Clinical presentation, imaging findings, anatomical extent, treatment strategies, and outcomes were recorded. Lesions were classified according to imaging-defined anatomical extension. A narrative literature review was also performed, and previously reported cases were retrospectively reinterpreted with attention to anatomical extent, deep-space involvement, and skeletal asymmetry. RESULTS: Twenty-two patients were included. Facial swelling or asymmetry was the most common presenting manifestation (21 of 22 patients, 95.5%). Fifteen lesions (68.2%) extended beyond the buccal component, most commonly into the infratemporal and pterygomandibular regions. According to the extension-based classification, seven lesions were categorized as Type I, 10 as Type II, and five as Type III. Image-guided sclerotherapy was performed as the initial treatment in all patients. Additional soft-tissue contouring was performed in 10 patients, and osteoplasty was performed in three. Lesion-related symptoms resolved completely in 17 patients (77.3%) and improved in five (22.7%). Facial symmetry was restored in 15 patients (68.2%) and improved in seven (31.8%). Retrospective reinterpretation of 12 previously reported cases showed similar anatomical extension patterns. CONCLUSION: BFP VMs show reproducible anatomical extension patterns, most commonly with spread beyond the buccal component into adjacent deep facial spaces. Recognition of these patterns may facilitate imaging assessment, treatment planning, and staged correction of facial asymmetry.