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

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

Background

Operating on temporal cutaneous tumors is challenging because of the intricate facial nerve system, particularly the frontal branches, and the possibility of brow dysfunction. Surgery for deep margin clearance is difficult because of the fragile and sensitive soft tissue in the temporal region. To address this research gap, this study assessed clearance margins, types of skin tumors, and nerve injuries in this critical anatomical position. This retrospective study assessed temporal skin cancer surgery, malignancy types, and clearance margins in patients with frontal-branch facial nerve injuries.

Methods

Forty-five patients with temporal skin carcinoma biopsies were analyzed. The deep and peripheral excision margins of skin malignancies were examined. Medical records were reviewed for clinically injured frontal nerve.

Results

Thirty-four patients were men (75%), and basal cell carcinoma was the most prevalent histological malignancy, followed by squamous cell carcinoma. The mean age of the patients was 77.8 years (39-107 years). Two patients experienced damage to the frontal branch nerve. Twenty-six percent of the skin malignancies had inadequate deep margin excision.

Conclusions

Removing temporal skin lesions is difficult. We discovered a 26% and 4% probability of inadequate deep margin excision and frontal branch facial nerve injury, respectively. Temporal skin lesions must be removed safely by surgeons to preserve the branches of the facial nerves. Insufficiently removed tumors require multidisciplinary teamwork and patient discussions regarding the advantages and risks to improve results.