Brow Ptosis After Temporal Artery Biopsy

Recently we described 4 patients referred over a period of 5 years after suffering facial nerve injury from superficial temporal artery biopsy. A literature search uncovered 3 more cases, bringing the total number of reported cases to 7. From this low number, we assumed that this complication was exceedingly rare. However, the actual incidence rate remained unknown because we were unable to determine how many uneventful biopsies had been performed by the surgeons who referred their patients to us. In our personal surgical experience, this complication had not been encountered. Subsequently, Murchison and Bilyk have made a valuable contribution by providing the first incidence data regarding the risk of damage to the frontalis branch of the facial nerve from temporal artery biopsy. Their results were surprising: 12 of 75 biopsies performed over 17 months resulted in facial nerve damage. Do the authors believe this complication rate of 16% is typical, or might it reflect some aspect of their technique, such as the choice of which segment of the artery to biopsy?