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Damage to the Temporal Branch of the Facial Nerve From Mohs Micrographic Surgery
Eileen L Axibal1, Marlie H Fisher2, Misha D Miller2
1Dermatology Associates of West Michigan, Grand Rapids, Michigan.
Background:
The temporal branch of the facial nerve is at risk of damage during Mohs micrographic surgery (MMS). This complication leads to motor deficit in the ipsilateral upper face with resultant functional and cosmetic impairment.
Objective:
To identify patient, tumor, and surgical risk factors associated with temporal nerve damage.
Materials And Methods:
A single-institution, retrospective review of MMS cases involving anatomic sites within the temporal nerve danger zone was performed. Risk factors were compared between cases with and without nerve damage.
Results:
Of 616 cases within the danger zone, 28 (4.5%) had postoperative nerve dysfunction. Variables significantly associated with dysfunction included patient immunosuppression, tumor size, aggressive tumor histology, recurrent tumors, high degree of subclinical spread, and greater average number of Mohs stages. Preoperative tumor size and postoperative defect size of ≥3 cm resulted in a ×37 and ×40 increased odds of nerve damage, respectively. Sex, age, and basal versus squamous cell carcinoma were not significantly associated with temporal nerve damage. No patients with a postoperative defect size measuring <2 cm had nerve damage.
Conclusion:
The overall risk of damage to the temporal nerve during MMS is low, but there are certain risk factors that warrant increased counseling about this potential complication.
Insights
Mohs micrographic surgery (MMS) poses a low risk of temporal nerve damage. Factors like immunosuppression, large or recurrent tumors, and extensive spread increase the risk, necessitating patient counseling.
Area of Science:
- Dermatologic Surgery
- Facial Nerve Anatomy
- Surgical Complications
Background:
- The temporal branch of the facial nerve is vulnerable during Mohs micrographic surgery (MMS).
- Damage can cause ipsilateral upper facial motor deficits, impacting function and aesthetics.
Purpose of the Study:
- Identify patient, tumor, and surgical factors linked to temporal nerve damage during MMS.
- Quantify the risk associated with specific clinical and pathological variables.
Main Methods:
- Retrospective review of 616 Mohs micrographic surgery cases in the temporal nerve danger zone.
- Comparison of risk factors between cases with and without temporal nerve dysfunction.
Main Results:
- 4.5% of cases (28/616) experienced postoperative temporal nerve dysfunction.
- Significant risk factors included patient immunosuppression, larger/recurrent tumors, aggressive histology, subclinical spread, and multiple Mohs stages.
- Defect size ≥3 cm significantly increased odds of nerve damage (×37 preoperative, ×40 postoperative).
- No damage occurred with postoperative defects <2 cm.
Conclusions:
- Temporal nerve damage risk in MMS is generally low but influenced by identifiable factors.
- Increased patient counseling is recommended for cases with elevated risk profiles.
