Injury to the frontal branch of the facial nerve is also an adverse event that can occur during the procedure. This usually happens when dissecting the TPF flap and including the anterior branch of the superficial temporal artery. In some cases, that anterior branch can be quite anterior and its course is very similar to the frontal branch. The nerve can be identified and preserved using a nerve simulator. Additionally, using the cautery at a low setting while dissecting the flap and looking at eyebrow twitches/contractions can give clues on how close one is from the frontal branch of the facial nerve. The anesthesia team should be informed to not give any paralytic agents during the procedure to be able to assess the nerve function during the procedure.
Moreover, it is of prime importance to perform a full facial nerve exam pre-operatively since partial or complete palsy of the facial nerve or its branches can occur in patients with microtia, specifically in patients with craniofacial microsomia. If a patient with no pre-operative palsy presents with a frontal branch palsy post-operatively, it could be either a neuropraxia or a complete intraoperative injury of the frontal branch of the facial nerve. In the majority of the cases, if a meticulous technique was used, it is a neuropraxia and the patient would observe a progressive return of function within the first 6-9 months post-operatively. If a non-reversible injury frontal branch injury is observed, it is important to determine the patient’s and his family expectations. Symmetry can be achieved by using/injecting a neuromodulator on the contralateral side.
If you have any questions about Microtia reconstruction or complications associated with it, come and visit us. Dr. Tahiri will discuss with you in depth the matter and will talk to you about the risks, benefits and alternatives associated with Microtia Reconstruction.
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