Temporal Artery Biopsy in a Dermatologic Surgery Practice

Albertini, John G.; Ramsey, Michael L.; Marks, Victor J.

doi:10.1046/j.1524-4725.1999.08296.x

Cited by 27 publications

(26 citation statements)

References 42 publications

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“…11 A small number of cases with postoperative brow ptosis has been reported in the literature, but to date the incidence and risk factors have not been studied. 5Ϫ8 The exact incidence of brow ptosis after TAB is confounded by Ն3 factors.…”

Section: Discussionmentioning

confidence: 99%

“…(2) A wide variety of "safety" and "danger zones" have been described based on anatomic, cadaveric studies, and the incidence of brow ptosis may vary by specific surgical technique. (3) Many patients needing TAB are referred to a specialist and are then told to follow-up with either their neuroophthalmologist or rheumatologist, and are seen by the surgeon only if incision site problems arise or contralateral TAB is needed 11 ; this in fact was the standard of the authors before this study. The issue of anticoagulant management in the perioperative period for oculoplastic surgical procedures has also been raised recently (Dutton J.…”

Section: Discussionmentioning

confidence: 99%

“…9,11,18Ϫ23 Given the inherent variability of both the facial nerve and the STA, the potential for injury to facial nerve branches during TAB is not surprising. Above the zygomatic arch, the STA travels in a serpiginous and somewhat predictable fashion within the superficial temporal fascia, 11,24 typically bifurcating into an anterior frontal and posterior parietal branch about 3 cm above the zygomatic arch. 23 The peripheral facial nerve has five or more common branching patterns.…”

Section: Discussionmentioning

confidence: 99%

“…Once these fibers cross over the zygomatic arch, the facial nerve branches lie within the anatomic equivalent of the superficial musculoaponeurotic system, traveling just deep to the superficial temporal fascia containing the STA, and course superiorly. 11,18,24,27 The superior path of the nerve may curve posteriorly before coursing anteriorly toward the brow, or follow a more direct path closer to the orbital rim. 28 Of note, the superficial temporal fascia is often thin and ill-defined, and becomes more indistinct with age.…”

Section: Discussionmentioning

confidence: 99%

“…28 Of note, the superficial temporal fascia is often thin and ill-defined, and becomes more indistinct with age. 11 At the level of the zygomatic arch, the frontal nerve branches typically congregate in the middle third of a line drawn between the tragus and lateral orbital rim, described by a variety of surface landmarks and ranges as 1.0 to 1.5 cm lateral to the lateral brow, 2 cm lateral to the lower lateral orbital rim, 3.5 cm from the lateral orbital rim at the level of the canthus, 1.0 to 1.5 cm above the superolateral orbital rim, or 0.8 to 3.5 cm anterior to the external auditory canal. 18,24,28,29 About 1 cm above the superior orbital rim, the nerve courses medially, at times as far as the corrugator.…”

Section: Discussionmentioning

confidence: 99%

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Brow Ptosis After Temporal Artery Biopsy

Yoon

McCulley²,

Horton

2013

Ophthalmology

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Objective: Temporal artery biopsy (TAB), performed for the diagnosis of giant cell arteritis, has a low reported rate of complications. One complication is damage to the facial nerve branches, which can result in brow ptosis and/or orbicularis oculi weakness. However, the incidence of facial nerve damage after TAB is unknown.Design: Prospective, institutional review board-approved study of all TABs performed by 2 surgeons over a 17-month period.Participants: Seventy patients undergoing 77 TABs. Methods: Demographic data, including age, gender, and race/ethnicity, were collected for all patients. Frontalis and orbicularis oculi muscle function were evaluated pre-and postoperatively in all patients. The use of blood thinners, location of the incision, length of incision and biopsy, biopsy results, and procedure difficulty were recorded. Incidence of postoperative facial nerve damage, other complications, and rates of facial nerve recovery were evaluated. Analysis of variables was performed for any potential correlation with facial nerve damage.Main Outcome Measures: Incidence of facial nerve damage. Results: Analysis included 75 biopsies performed in 68 patients. The majority of the patients were white (75.0%) and female (67.6%). The mean age was 72.6 years (range, 51-96). Postoperative facial nerve damage was found in 12 patients (16.0%) and 58.3% of these fully resolved at an average of 4.43 months (range, 1-6). Two patients (2.7%) had postoperative infections. There was no correlation with facial nerve damage and use of blood thinners, biopsy result, surgeon, procedure difficulty, incision length, or specimen length. The distance from the incision to both the orbital rim and the brow was significant: Incisions farther from the orbital rim and brow were less likely to have postoperative facial nerve damage.Conclusions: There is a 16.0% incidence of postoperative facial nerve damage with TABs, which recovers fully in over half of patients. Incisions closer to the orbital rim and brow were more likely to have postoperative facial nerve dysfunction. Incisions Ͼ35 mm from both the orbital rim and brow or above the brow were less likely to have postoperative brow ptosis. Financial Disclosure(s):

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Brow Ptosis After Temporal Artery Biopsy

Yoon

McCulley²,

Horton

2013

Ophthalmology

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A Comprehensive Evidence-Based Approach to Fever of Unknown Origin

Mourad¹,

Palda²,

Detsky³

2003

Arch Intern Med

297

160

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Surgical anatomy of the superficial temporal artery to prevent facial nerve injury during arterial biopsy

Shin

Lee

et al. 2017

Clinical Anatomy

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To investigate the topographical relationship between the frontal branch of the superficial temporal artery (FSTA) and the temporal branch of the facial nerve (TFN) with the aim of preventing nerve injury during FSTA biopsy. Fifty-seven hemifaces of 33 cadavers were dissected. Vertical lines drawn to the lateral orbital margin (LOM) and the superior root of the helix were used as the anterior and posterior reference positions, respectively. Horizontal lines drawn through the supraorbital margin and lateral canthus were used as the superior and inferior reference points, respectively. The depth and course relationships of the FSTA and TFN were examined. Midpoints between the FSTA and TFN are situated approximately 6.0 and 4.5 cm posterior to the lateral orbital margin at the levels of the lateral canthus and supraorbital margin, respectively. The TFN is generally situated 1-2 cm anteriorly and inferiorly to the FSTA in the temporal region. However, in two cases (3.6%), the TFN ran just underneath the FSTA with only a very small safe distance, making it highly vulnerable to iatrogenic injury. In conclusion, when performing an FSTA biopsy, the surgeon should not dissect below the superficial temporal fascia because there is an overlap between the course of the FSTA and the TFN in a minority of cases. Also, surgical incisions should be made outside the area delineated by an oblique line passing through the points 6.0 and 4.5 cm posterior to the lateral orbital margin at the levels of the lateral canthus and the supraorbital margin, respectively. Clin. Anat. 31:608-613, 2018. © 2017 Wiley Periodicals, Inc.

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Temporal Artery Biopsy in a Dermatologic Surgery Practice

Abstract: TAB is a quick, safe, straightforward, and gratifying office procedure which dermatologic surgeons are very qualified to perform.

Cited by 27 publications

References 42 publications

Brow Ptosis After Temporal Artery Biopsy

Brow Ptosis After Temporal Artery Biopsy

A Comprehensive Evidence-Based Approach to Fever of Unknown Origin

Surgical anatomy of the superficial temporal artery to prevent facial nerve injury during arterial biopsy

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