of Temporal Trigger Sites

Fig. 13.1

Preoperative Doppler of the temporal region

../images/481431_1_En_13_Chapter/481431_1_En_13_Fig2_HTML.png — Fig. 13.2

Local anesthesia

Trichophyte skin incision (Fig. 13.3) is carefully made with a n°15 blade in order to hide the resulting scar. Accurate hemostasis is performed taking care not to damage hair bulbs in the subcutaneous tissue. In case of diffuse bleeding, 60-s local compression with sterile gauze soaked into a H₂O₂ solution is usually enough.

../images/481431_1_En_13_Chapter/481431_1_En_13_Fig3_HTML.png — Fig. 13.3

Skin incision

Dissection is taken deep to the superficial temporal fascia (Fig. 13.4) by blunt-tip Metzenbaum scissor taken deep until both STA and ATN are exposed and isolated (Figs. 13.5, 13.6, 13.7, 13.8, 13.9, 13.10, 13.11, 13.12, 13.13, 13.14, 13.15, 13.16, 13.17, 13.18, and 13.19). ATN usually lies superficial and posterior to the STA. Once these two structures are isolated from each other and from surrounding tissue, the STA is simply ligated (Figs. 13.20, 13.21, 13.22, 13.23, 13.24, 13.25, 13.26, 13.27, 13.28, and 13.29) both proximally and caudally to the area of nerve-artery intersection/helical intertwining. Lately, we’ve begun performing coagulation (Figs. 13.30 and 13.31) of the STA in order to reduce the risk of foreign body reaction that may be caused by the suture material.