Abstract: Objective: To investigate the role of middle temporal vein in coronal incision. Methods: Thirty-six patients with zygomatic fractures in our hospital were included. All fracture segments were exposed by coronal incision along the plane of middle temporal vein or deep temporal fascia. Factors taken into the study included flapping time, bleeding volume, variation of middle temporal vein, and clinical outcomes. Results: The middle temporal vein ran constantly through superficial part of temporal fat pad between the two layers of deep temporal fascia. All 18 middle temporal vein cases were recorded without middle temporal vein missing, with successful flapping, intact temporal fat pad, good exposure, and satisfactory reduction of fractures. Transient facial paralysis was reduced significantly in the middle temporal vein group, while permanent facial nerve injury and temporal hollowing showed no significant difference. Conclusion: Temporal flapping guided by middle temporal vein is a simple and clear way that can reduce facial nerve injury and temporal hollowing in coronal incision.

Key words: Coronal incision, Middle temporal vein, Anatomical plane, Facial nerve injury, Temporal hollowing