Damage to the Temporal Branch of the Facial Nerve From Mohs Micrographic Surgery

Abstract

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 337 and 340 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.

Maintaining Functionality in Temporal Skin Tumor Surgery: A Focus on Nerve Injury and Excision Margins

“…9 After frontal nerve injury, some patients are not disturbed by the droopy eyebrow; however, in some cases, it has a significant effect and the patient may require a brow-lift procedure. [11][12][13] Another factor to consider is the age of the patient, as in younger patients, there is an argument to perform immediate nerve repair under the microscope if removal of the lesion is suspected to likely cause frontal branch injury. 14 It is challenging to visualize the frontal nerve branch, even under loupes magnification, and it may require surgical microscopic magnification.…”

Commentary on “Damage to the Temporal Branch of the Facial Nerve From Mohs Micrographic Surgery”

“…Axibal and colleagues 1 reviewed 616 cases of Mohs micrographic surgery (MMS) in the temporal nerve danger zone, identified patients with motor nerve damage, and proposed risk factors for this complication after MMS. Of all 6,875 cases reviewed in this time frame, 9.2% involved this location.…”