Temporal Dissection Technique That Prevents Temporal Hollowing in Coronal Approach

Temporal hollowing after lateral facial skeletal exposure via a coronal approach is not uncommon. This is caused by injury to the superficial temporal fat pad. However, to prevent facial nerve injury at the zygomatic arch, incision of the superficial layer of the temporalis fascia (TF) and exposure of the temporal fat pad are accompanied with most coronal approaches. Here we introduce our method of dissection of the suprasuperficial layer of the TF without exposure of the temporal fat pad and report on its safety and efficacy. Temporal dissection just superficial to the superficial layer of the TF was performed to the superior border of the zygomatic arch. After identifying the zygomatic arch, an incision was made at the posterosuperior aspect of the arch, when exposure of the arch was necessary for access to the lateral skeleton. From 1989 to 2008, 522 patients undergoing craniofacial surgery via coronal approach were analyzed retrospectively. No patient developed temporal hollowing. However, 14 patients (2.7%) developed frontal weakness immediately postoperatively, and 2 of them had permanent paresis. The frequency of this motor morbidity was low compared with that of other reports. Preservation of the temporal fat pad in coronal approach is essential for the prevention of temporal hollowing, and for this, we recommend suprasuperficial layer of TF dissection.