Purchase this article with an account.
C. Kum, M. K. Yoon, B. Shapiro, T. J. McCulley; Assessment of Facial Nerve Injury After Temporal Artery Biopsy. Invest. Ophthalmol. Vis. Sci. 2010;51(13):5472.
Download citation file:
© ARVO (1962-2015); The Authors (2016-present)
Temporal artery biopsy, the gold standard for the diagnosis of giant cell arteritis, is generally considered to be a benign procedure. In this report we describe four patients with facial nerve injury secondary to biopsy.
A review of the records in a tertiary care referral neuro-ophthalmology practice from October 2004 to January 2009 was performed. Patients who had facial nerve injury after temporal artery biopsy were included.
Four patients (two men and two women) ranging in age from 60 to 87 years (mean age 72.8 years) were included. All patients were referred for evaluation of facial nerve palsy following temporal artery biopsy. Three patients had unilateral biopsy and one patient had bilateral biopsy. Based on clinical photographs and examination records, all the patients had their biopsy performed either in the pre-auricular region or within three cm of the lateral orbital rim. Self-reported improvement in frontalis function ranged from 0% (no improvement) to 75% (mean 35%). No patients underwent surgery to correct brow position. There were no other complications of biopsy.
Branch facial nerve palsy can occur with temporal artery biopsy. Dysfunction will likely be permanent. This appears to relate primarily to incision location. All patients in our review had incisions either low (pre-auricular) or relatively medial (approaching the level of the lateral canthal angle). Avoidance of the frontal branch of the facial nerve might be better achieved by placement of the incision sufficiently superior and lateral. Although facial nerve injury is rare, it is crucial to have a complete understanding of facial planes and anatomical relationships when performing any surgery, even if seemingly benign, such as a temporal artery biopsy.
This PDF is available to Subscribers Only