During reduction malarplasty using both intraoral and preauricular incisions, the operative exposure of the preauricular incision can result in injury of the temporal branch of the facial nerve, a potentially serious complication. The purpose of this study was to determine the relative frequency of this injury and investigate potential methods of prevention by analyzing the related anatomic and functional details of the patients that sustained temporal branch injury.

The study comprised a retrospective review of 93 patients who underwent L-shaped reduction malarplasty with osteotomy using intraoral and preauricular incisions between December 2018 and February 2021. Specifically, this included all patients with transient dysfunction of the temporal branch of the facial nerve 1 week postoperatively, which recovered with conservative treatment.

In 4 of the 93 operated cases, the postoperative evaluation revealed that the forehead lines disappeared, there was a failure of eyebrow lifting, double eyelids remained unchanged in 3 cases and narrowed in 1, but eye closure was not affected. However, using only conservative treatment, the symptoms of all patients improved and recovered.

To avoid the temporal branch of facial nerve injury during reduction malarplasty with intraoral and preauricular incisions, surgeons need to be especially familiar with the anatomy of the temporal branch of the facial nerve and proceed with precise, atraumatic dissection. However, if facial paralysis is diagnosed postoperatively, active treatment should be undertaken as soon as possible.

Level IV