Temporal dissection technique that prevents temporal hollowing in coronal approach.

Area of Science:

• Craniofacial Surgery
• Plastic Surgery
• Surgical Anatomy

Background:

• Temporal hollowing is a frequent complication following lateral facial skeletal exposure using the coronal approach.
• This aesthetic deformity is attributed to injury of the superficial temporal fat pad.
• Standard coronal approaches often necessitate incision and exposure of the temporal fat pad to prevent facial nerve injury.

Purpose of the Study:

• To introduce and evaluate a modified dissection technique for the coronal approach.
• The technique aims to avoid exposure of the superficial temporal fat pad.
• To assess the safety and efficacy of this suprasuperficial dissection in preventing temporal hollowing.

Main Methods:

• A retrospective analysis of 522 patients undergoing craniofacial surgery between 1989 and 2008.
• The modified technique involved dissection superficial to the superficial layer of the temporalis fascia (TF).
• Dissection extended to the superior border of the zygomatic arch, with incisions made cautiously when zygomatic arch access was required.

Main Results:

• No patients in the study cohort developed temporal hollowing.
• A low incidence of motor morbidity was observed: 14 patients (2.7%) experienced temporary frontal weakness, with 2 cases of permanent paresis.
• The rate of motor complications was comparable to or lower than reported rates for other coronal approach techniques.

Conclusions:

• Preservation of the superficial temporal fat pad is crucial for preventing temporal hollowing in coronal approaches.
• The described suprasuperficial layer of temporalis fascia dissection is a safe and effective method to achieve this.
• This technique offers a viable alternative for craniofacial surgeons seeking to improve aesthetic outcomes.