It is possible to injure the temporal branch of the facial nerve during Mohs micrographic surgery (MMS). Because of this problem, the affected individual’s ipsilateral upper face may experience motor deficits, compromising their facial function and appearance. The goal of this study is to determine patient, tumor, and surgical risk factors linked with temporal nerve injury. Researchers conducted a retrospective study of MMS patients at a single institution where the affected area was near the temporal nerve. Cases with and without nerve injuries were examined for risk variables.

There were 28 incidences of postoperative nerve dysfunction out of 616 occurred inside the danger zone or 4.5%. Immunosuppression of the patient, tumor size, tumor aggressiveness, recurrent tumors, extensive subclinical dissemination, and a higher-than-average number of Mohs stages were all significant predictors of dysfunction. If the size of the tumor preoperatively or the defect postoperatively was greater than or equal to 3 cm, the likelihood of nerve injury rose by a factor of x37 and x40, respectively. 

Temporal nerve injury was not significantly linked to either sex, age, or basal versus squamous cell cancer. The nerves of no postoperative patients with defects smaller than 2 centimeters were damaged. There is a modest chance of temporal nerve injury during MMS; however, some risk factors should prompt more extensive counseling.

Source: journals.lww.com/dermatologicsurgery/Abstract/2022/11000/Damage_to_the_Temporal_Branch_of_the_Facial_Nerve.2.aspx