Temporal hollowing following coronal incision: a prospective, randomized, controlled trial.
BACKGROUND
Coronal incisions are used in traumatic, reconstructive, and cosmetic procedures to access the lateral facial skeleton. Temporal hollowing is a common complication following coronal incision that affects the patient both physically and psychologically. Several dissections have been recommended through this area to avoid injury to the frontal branch of the facial nerve and the temporal fat pad, which is thought to be the cause of hollowing. The purpose of this study was to identify the cause of postoperative temporal hollowing.


METHODS
Patients requiring a coronal incision were recruited prospectively. Each side of the head in all patients was randomized to suprafascial, subfascial, or deep dissection. An unmarked envelope containing the type of dissection to be performed for each side was used. All envelopes contained equal distributions of all groups. The incidence and severity of temporal hollowing 6 months postoperatively were measured clinically and by computed tomographic volume analysis.


RESULTS
Twenty-seven patients with 54 sides (18 suprafascial, 15 subfascial, and 21 deep) completed the study. There were no demographic differences among the three groups. The incidence and severity of temporal hollowing were lowest with suprafascial dissection. Other factors associated with the presence of temporal hollowing included a reduction in body mass index. There were no injuries to the frontal nerve in any of the dissections. Postoperative temporal hollowing was associated with surgical approach and postoperative weight loss.


CONCLUSIONS
Elevation of a coronal flap in the suprafascial plane and minimization of patient weight loss may decrease the incidence of postoperative temporal hollowing.
London, Ontario, Canada From the Division of Plastic and Reconstructive Surgery, University of Western Ontario.
Damir B
DB
Matic
Sharon
S
Kim
D000273:Adipose Tissue / Q000098:blood supply / Q000293:injuries / Q000473:pathology*; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016009:Chi-Square Distribution; D005146:Facial Asymmetry / Q000209:etiology / Q000601:surgery*; D005205:Fascia / Q000098:blood supply / Q000473:pathology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D011336:Probability; D011446:Prospective Studies; D019651:Plastic Surgery Procedures / Q000009:adverse effects* / Q000379:methods; D012016:Reference Values; D018570:Risk Assessment; D013524:Surgical Flaps; D013536:Suture Techniques; D013703:Temporal Muscle / Q000098:blood supply* / Q000293:injuries / Q000473:pathology; D016896:Treatment Outcome