title: The Deep Temporal Nerve Transfer: An Anatomical Feasibility Study and Implications for Upper Facial Reanimation.
abstract: BACKGROUND
  Facial paralysis has a profound impact on the brow, and currently static procedures are the mainstay of treatment. The deep temporal branches of the trigeminal nerve, given their proximity to the brow, may serve as possible donor nerves for both potential innervation of a free muscle transfer in patients with prolonged facial palsy or nerve transfers in acute or subacute palsy. As such, the authors present the detailed surgical anatomy of the deep temporal nerve, assessing feasibility for both functional muscle and nerve transfers, including a proposed surgical technique.
  
  
  METHODS
  Thirty cadaver hemifaces were dissected to establish deep temporal nerve anatomy and perform axonal analysis.
  
  
  RESULTS
  Two (53 percent) or three (47 percent) divisions of the deep temporal nerve were noted, with the most consistent division being the middle division (30 of 30 specimens). This division was consistently found approximately 4.1 cm (range, 3.7 to 4.5 cm) anterior to the tragus at the level of the zygomatic arch. For each 1 cm cranial to the arch, the nerve courses approximately 1 mm posteriorly. The number of axons in the proposed temporal branch is 1469 as it emerges from behind the zygomatic arch, 889 at 1 cm, 682 at 2 cm, 534 at 3 cm, 355 at 4 cm, 377 at 5 cm, and 256 at 6 cm.
  
  
  CONCLUSIONS
  Given its anatomical consistency, and expendability, the middle division of the deep temporal nerve is a viable donor nerve for dynamic upper facial reanimation with either nerve transfer or functional muscle transfer, depending on the length of facial palsy.
  
  
  METHODS
  Therapeutic, V.
authors.affiliation: Dallas, Texas; Mexico City, Mexico; and Beirut, Lebanon.|From the Departments of Plastic Surgery and Pathology, University of Texas Southwestern Medical Center; the Division of Plastic Surgery, Hospital General Dr. Manuel Gea Gonzalez; and the Department of Plastic Surgery, American University in Beirut Medical Center.
authors.forename: Phillip B
authors.initials: PB
authors.lastname: Dauwe
authors.affiliation: Dallas, Texas; Mexico City, Mexico; and Beirut, Lebanon.|From the Departments of Plastic Surgery and Pathology, University of Texas Southwestern Medical Center; the Division of Plastic Surgery, Hospital General Dr. Manuel Gea Gonzalez; and the Department of Plastic Surgery, American University in Beirut Medical Center.
authors.forename: Austin
authors.initials: A
authors.lastname: Hembd
authors.affiliation: Dallas, Texas; Mexico City, Mexico; and Beirut, Lebanon.|From the Departments of Plastic Surgery and Pathology, University of Texas Southwestern Medical Center; the Division of Plastic Surgery, Hospital General Dr. Manuel Gea Gonzalez; and the Department of Plastic Surgery, American University in Beirut Medical Center.
authors.forename: Erika
authors.initials: E
authors.lastname: De La Concha-Blankenagel
authors.affiliation: Dallas, Texas; Mexico City, Mexico; and Beirut, Lebanon.|From the Departments of Plastic Surgery and Pathology, University of Texas Southwestern Medical Center; the Division of Plastic Surgery, Hospital General Dr. Manuel Gea Gonzalez; and the Department of Plastic Surgery, American University in Beirut Medical Center.
authors.forename: Salim
authors.initials: S
authors.lastname: Saba
authors.affiliation: Dallas, Texas; Mexico City, Mexico; and Beirut, Lebanon.|From the Departments of Plastic Surgery and Pathology, University of Texas Southwestern Medical Center; the Division of Plastic Surgery, Hospital General Dr. Manuel Gea Gonzalez; and the Department of Plastic Surgery, American University in Beirut Medical Center.
authors.forename: Charles
authors.initials: C
authors.lastname: White
authors.affiliation: Dallas, Texas; Mexico City, Mexico; and Beirut, Lebanon.|From the Departments of Plastic Surgery and Pathology, University of Texas Southwestern Medical Center; the Division of Plastic Surgery, Hospital General Dr. Manuel Gea Gonzalez; and the Department of Plastic Surgery, American University in Beirut Medical Center.
authors.forename: Alexander
authors.initials: A
authors.lastname: Cardenas-Mejia
authors.affiliation: Dallas, Texas; Mexico City, Mexico; and Beirut, Lebanon.|From the Departments of Plastic Surgery and Pathology, University of Texas Southwestern Medical Center; the Division of Plastic Surgery, Hospital General Dr. Manuel Gea Gonzalez; and the Department of Plastic Surgery, American University in Beirut Medical Center.
authors.forename: Shai M
authors.initials: SM
authors.lastname: Rozen
mesh_terms: D003391:Cranial Nerves / Q000473:pathology* / Q000637:transplantation*; D005158:Facial Paralysis / Q000601:surgery*; D005240:Feasibility Studies; D005546:Forehead / Q000294:innervation*; D006801:Humans; D016067:Nerve Transfer / Q000379:methods*