We read with great interest the recent report by Yoon and associates describing 4 patients with iatrogenic facial nerve injury sustained during temporal artery biopsy. They correctly describe the danger zone involving the area traversed by the frontal branch of the superficial temporal artery as being a site where facial nerve injury is possible if careful surgical dissection is not performed. We would like to share our preferred method of temporal artery biopsy that decreases the risk of facial nerve injury and improves the cosmetic appearance of the resultant scar without increasing surgical duration.
Like Yoon and associates, we prefer to biopsy the parietal branch of the superficial temporal artery within the hair line, after either palpation or Doppler ultrasound confirms the course of the vessel that is marked before surgery. We agree that this decreases the risk of possible facial nerve injury and leaves a hidden resultant scar. A difference in our technique is that we do not shave any hair. We simply use bacitracin ointment to part the hair at the surgical mark, and proceed with our dissection. We find that the hair does not complicate the surgical dissection or wound closure using this method and that this saves the patient from having a bald patch in the postoperative period. Female patients are especially appreciative of this benefit.
In summary, we agree with Yoon and associates’ suggestion that all surgeons biopsy the parietal, rather than the frontal, branch of the superficial temporal artery to avoid potential facial nerve injury. We also suggest to the readership that placing the surgical incision completely within the hair line, after parting the hair with ointment, allows less risk of facial nerve injury and results in a hidden postoperative scar without a bald patch in the postoperative period. This technique, in our experience, takes approximately 20 to 30 minutes and is accomplished safely with monitored anesthesia care sedation.