An audit of 50 bitemporal flaps in primary facial trauma

The bitemporal (bicoronal) flap is a well recognised technique for exposing the skull and upper face. Prospectively collected data over a 5-year period in which this technique was used for access in primary craniomaxillofacial trauma was analysed. Emphasis was placed on indications, complications and outcome. A total of 50 cases were audited. 84% were male. 74% had sustained midface or frontal bone trauma, 24% had lateral upper face injuries. Only 1 patient had a penetrating missile injury. Consistent complications of the procedure were altered sensation at the vertex in the early postoperative period and a small area of wound breakdown over the suture knot in the galea. In all cases the altered sensation greatly improved or resolved, 12% developed a wound infection, however, 83% of these were trivial requiring no active treatment. There was an isolated case of pressure necrosis over a drain site. 12% had a demonstrable transient deficit of the temporal branch of the facial nerve, all of which improved.