Temporal Region, Surgical Anatomy: Keep it Simple!

Abdulrauf Badr Mi

doi:10.36959/357/454

Abstract

Abstract Due to the several layers of fasciae and their interchanging characteristics below and above the zygomatic arch, the temporal region anatomy has somewhat been unpleasant to comprehend and recall. The frontal branch of facial nerve is however the ultimate reason why it becomes important to study this area. Many surgical specialties need to work on this region, some of the common procedures include Coronal approaches; Zygoma fracture reduction; Temporoparietal flap elevation; Face and brow lift. We believe there is a need for clear and doubt free messages to be made in regard this topic. After an extensive literature search, we came up with few conclusions and key illustrations that we strongly believe are crucial to be remembered. The rationale of following certain path of dissection in the temporal region, depending on the planned operation is explained. Eponyms used in literature for various structures have been discussed and clarified. The relationship of the frontal nerve to its surrounding fasciae within the zygomatic zone and Temporoparietal fascia is further explored. This review and guidelines are specifically been developed and recommended as an educational tool for in training surgical residents of concerned specialties.

Highlights

The Temporal region (TR) is a common site for several surgical interventions and approaches, it has interesting anatomical details and it is a transition zone between the scalp; occiput; forehead and the face.Surgical specialties that are frequently involved in this area include: Neurosurgery; Otorhinolaryngology; Head and Neck; Maxillofacial; Plastic aesthetic and Reconstructive surgery.Historically, there are several excellent studies and papers by pioneer authors on ways to protect the frontal nerve (FN) branch of the facial nerve [1,2,3,4,5].Stuzin, et al came up with their famous study and were the first to describe location of the FN in relation to Temporoparietal fascia (TPF), as being just underneath it when cephalad to the Zygomatic Arch (ZA)
In Coronal brow lift procedure, the dissection is initially under the TPF level until approximately 2 cm above the upper border of the ZA, the superficial layer of Deep temporal fascia (DTF) is penetrated and dissection continues within the superficial fat pad
Upon vein’s visualization intra-operatively the dissection must be slowed down and more cautious tissue handling is recommended

Summary

Introduction

The Temporal region (TR) is a common site for several surgical interventions and approaches, it has interesting anatomical details and it is a transition zone between the scalp; occiput; forehead and the face. Et al came up with their famous study and were the first to describe location of the FN in relation to TPF, as being just underneath it when cephalad to the ZA They advised the safe level of dissection would either be superficial to TPF or otherwise under the superficial layer of DTF within the superficial fat pad [1]. There are less differences in opinions regarding the level at which the nerve takes its path [4]. What may make this region look often confusing is two folds: one, the terminology used for various layers, fasciae are inconsistent between the specialties and even among the same specialty. Beyond the Subcutaneous fat layer there is a general scheme of different layers of tissues in the face, unlike anywhere else in the body [4]:

Deep muscles

Discussion

Conclusion