title: Brow ptosis after temporal artery biopsy: incidence and associations.
abstract: OBJECTIVE
  Temporal artery biopsy (TAB), performed for the diagnosis of giant cell arteritis, has a low reported rate of complications. One complication is damage to the facial nerve branches, which can result in brow ptosis and/or orbicularis oculi weakness. However, the incidence of facial nerve damage after TAB is unknown.
  
  
  METHODS
  Prospective, institutional review board-approved study of all TABs performed by 2 surgeons over a 17-month period.
  
  
  METHODS
  Seventy patients undergoing 77 TABs.
  
  
  METHODS
  Demographic data, including age, gender, and race/ethnicity, were collected for all patients. Frontalis and orbicularis oculi muscle function were evaluated pre- and postoperatively in all patients. The use of blood thinners, location of the incision, length of incision and biopsy, biopsy results, and procedure difficulty were recorded. Incidence of postoperative facial nerve damage, other complications, and rates of facial nerve recovery were evaluated. Analysis of variables was performed for any potential correlation with facial nerve damage.
  
  
  METHODS
  Incidence of facial nerve damage.
  
  
  RESULTS
  Analysis included 75 biopsies performed in 68 patients. The majority of the patients were white (75.0%) and female (67.6%). The mean age was 72.6 years (range, 51-96). Postoperative facial nerve damage was found in 12 patients (16.0%) and 58.3% of these fully resolved at an average of 4.43 months (range, 1-6). Two patients (2.7%) had postoperative infections. There was no correlation with facial nerve damage and use of blood thinners, biopsy result, surgeon, procedure difficulty, incision length, or specimen length. The distance from the incision to both the orbital rim and the brow was significant: Incisions farther from the orbital rim and brow were less likely to have postoperative facial nerve damage.
  
  
  CONCLUSIONS
  There is a 16.0% incidence of postoperative facial nerve damage with TABs, which recovers fully in over half of patients. Incisions closer to the orbital rim and brow were more likely to have postoperative facial nerve dysfunction. Incisions >35 mm from both the orbital rim and brow or above the brow were less likely to have postoperative brow ptosis.
  
  
  BACKGROUND
  The authors have no proprietary or commercial interest in any of the materials discussed in this article.
authors.affiliation: Wills Eye Emergency Room, Wills Eye Institute, Philadelphia, Pennsylvania 19107, USA. amurchison@willseye.org
authors.forename: Ann P
authors.initials: AP
authors.lastname: Murchison
authors.forename: Jurij R
authors.initials: JR
authors.lastname: Bilyk
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001706:Biopsy / Q000009:adverse effects*; D001763:Blepharoptosis / Q000209:etiology* / Q000503:physiopathology; D005138:Eyebrows / Q000473:pathology*; D020220:Facial Nerve Injuries / Q000209:etiology* / Q000503:physiopathology; D005260:Female; D013700:Giant Cell Arteritis / Q000175:diagnosis*; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009801:Oculomotor Muscles / Q000503:physiopathology; D011183:Postoperative Complications; D011446:Prospective Studies; D013699:Temporal Arteries / Q000000981:diagnostic imaging / Q000473:pathology*; D018608:Ultrasonography, Doppler