BIOANATOMY AND BIOMECHANICS
The temple lies lateral to the eye and anterior to the ear. Its inferior border is defined by the zygomatic process of the temporal bone and its medial border is the zygoma itself, as it ascends lateral to the orbit. The superior border is defined by the subtle deflection from the concavity of the temporal fossa to the convexity of the frontal bone. There is great variability in the amount of non-hair-bearing skin anterior and inferior to the hairline (Fig. 13.1) and this factors into how operative wounds of the temple are repaired.
Variations in the anatomy of the temple. (A) Typical temple. There is a modest distance between the anterior hairline and the lateral brow. (B) Diminutive temple. The scalp/hairline extends anteriorly. (C) Broad temple. The hairline has receded and the area of non-hair-bearing skin is large
The temple has a predictable vascular supply from branches of the superficial temporal artery. These are large caliber vessels and run within the superficial fascia. They are readily identified and avoided at the time of surgery. If the main branches are transected at surgery, they should be ligated. The small perforators that emerge through the fascia also require meticulous hemostasis. In most patients, an easily identified and relatively avascular undermining plane exists just above the superficial fascia (Fig. 13.2). The main nerve of interest is the frontal branch of the temporal nerve. As reviewed extensively in Chapter 1, frontal branch of the temporal nerve is vulnerable in the superficial fascia from the zygomatic arch to the lateral forehead (Fig. 13.3).1 One sensory nerve of note is the auriculotemporal nerve that innervates the upper ear and runs just anterior to the ear at the lateral junction of the temple and cheek (Fig. 13.4). Trauma to the auriculotemporal nerve can lead to long-lasting numbness or neuralgia.
Undermining plane on the temple. This flap is elevated just above fascia. The superficial fascia envelopes and protects the branches of the temporal artery and the frontal branch of the facial nerve
The frontal branch of the facial nerve is identified and preserved during a repair
The auriculotemporal nerve and its anterior branch are shown. Trauma to this nerve is a frequent source of neuritic pain
In most individuals, the temple has a well-defined layer of adipose overlying the superficial temporal fascia, and the surface tissues usually enjoy substantial mobility, especially from the lower temple and cheek. Large flaps may be elevated just above fascia in a relatively ...