2026 Proffered Presentations
S124: SURGICAL ANATOMY OF INTERFASCIAL DISSECTION FOR SAFE EXPOSURE OF THE ZYGOMATIC ARCH
Serdar Rahmanov, MD; Abdulrahman Albakr, MD; Mohammadmahdi Sabahi, MD; Hamid Borghei-Razavi, MD; Badih Adada, MD; Cleveland Clinic Florida
Introduction: Safe exposure of the zygomatic arch remains one of the more technically demanding aspects of anterior and middle skull base approaches. The central challenge lies in preserving the frontal branch of the facial nerve while minimizing functional and aesthetic morbidity. Interfascial dissection provides a valuable option by preserving the temporalis muscle and its fascial coverings while reducing the risk of nerve injury. The method, however, requires precise anatomical knowledge and technical execution to avoid misdissection. The present study sought to provide a detailed anatomical description of the interfascial dissection technique and evaluate its effectiveness in cadaveric models.
Methods: Eight formalin-fixed cadaveric heads (16 sides) were dissected using a stepwise approach to expose the temporal region and zygomatic arch. The dissection focused on defining the anatomical relationship between the superficial and deep layers of the temporal fascia, the course of the frontal branch of the facial nerve, and the fascial planes available for safe surgical dissection. Attention was given to preserving the temporalis muscle bulk, maintaining fascial integrity, and identifying technical landmarks that guide correct interfascial separation. Documentation included high-resolution photography and video recording to illustrate each stage of the dissection.
Results: In all specimens, an avascular plane between the superficial and deep layers of the temporal fascia was consistently identified. This interfascial plane provided a reproducible and safe surgical corridor for exposure of the zygomatic arch. The frontal branch of the facial nerve remained protected within the superficial fascial layer, minimizing the risk of iatrogenic injury during exposure. Preservation of the temporalis muscle bulk was consistently achieved, facilitating potential reattachment and reducing the risk of postoperative muscle atrophy. The technique was reproducible in all 16 dissections and offered clear anatomic landmarks that enhanced surgical orientation.
Conclusion: Interfascial dissection is a safe, reliable, and anatomically consistent method for exposure of the zygomatic arch. It allows protection of the frontal branch of the facial nerve, preservation of temporalis muscle volume, and maintenance of fascial integrity. These features support its role as a valuable technique for optimizing surgical safety and functional as well as aesthetic outcomes in skull base surgery.
