Safety of Modified Coronal Approach with Dissection Deep to Temporalis Fascia for Facial Nerve Preservation

Objective To evaluate the safety of a modified coronal approach to the upper craniofacial skeleton with dissection deep to the temporalis fascia for enhanced preservation of the frontal branch of the facial nerve. Study Design Case series with chart review. Setting Tertiary academic medical center. Subjects and Methods In total, 271 patients undergoing coronal flap approaches to the upper craniofacial skeleton by a single surgeon from January 2008 through December 2013 were included. Primary outcomes are temporary or permanent weakness of the frontal branch of the facial nerve as well as the incidence of temporal hollowing following surgery. Secondary outcomes include the presence of postoperative hematoma, seroma, infection, scarring, and alopecia. Results There were no cases involving either temporary or permanent facial nerve weakness. The incidence of other postoperative complications was also exceedingly low, including a hematoma rate of less than 1%, widened scarring in 2.6% of patients, and no cases of clinically significant temporal hollowing encountered during a mean follow-up period of 3 years. Conclusion A modified coronal approach with dissection deep to the temporalis fascia offers a safe and reliable surgical technique for accessing the upper craniofacial skeleton. Observed complications were minimal, and despite this deeper plane of dissection, there were no cases of either temporary or permanent facial nerve weakness in a large retrospective series of patients from over the past 6 years. Consideration should be given for the routine use of this modified coronal approach for both reconstructive as well as cosmetic indications.