Temporal artery biopsy: time for a rethink on training?

Area of Science:

• Ophthalmology
• Surgical Training
• Anatomy

Background:

• Temporal artery biopsy (TAB) is frequently performed by ophthalmology trainees with limited direct supervision.
• The traditional 'see one, do one, teach one' model is prevalent, despite potential risks.
• Damage to the temporal branch of the facial nerve is a known complication during TAB, particularly when harvesting the frontal branch.

Purpose of the Study:

• To assess current training practices, anatomical knowledge, and procedural techniques among ophthalmology trainees performing TAB.
• To identify deficiencies in formal anatomical education related to TAB.
• To evaluate trainee awareness of and adherence to facial nerve safety zones during TAB.

Main Methods:

• A survey was distributed to ophthalmology trainees across multiple deaneries (Wessex, Wales, London, Severn).
• The survey collected data on training methods, anatomical knowledge, and surgical site selection for TAB.
• Responses from 38 trainees, with complete data from 28, were analyzed.

Main Results:

• No trainees reported formal anatomical teaching for TAB; informal teaching was standard.
• While 61% knew the facial nerve 'danger zone', 97% selected incisions within this zone.
• This indicates a significant gap between awareness and practice regarding facial nerve protection.

Conclusions:

• Temporal artery biopsy is largely a trainee-taught and performed procedure with inadequate formal anatomical training.
• Most trainees are unaware of how to mitigate the risk of temporal branch facial nerve damage.
• Harvesting the parietal branch of the temporal artery via an incision outside the 'danger zone' is proposed as a safer, easily teachable alternative.