Temporal nerve neuropraxia and contralateral compensatory brow elevation.

An 80-year-old woman presented for surgical treatment of an invasive squamous cell carcinoma on the left temple (Figure 1). The lesion had been present for several months and had been enlarging. The patient did not have any motor deficit in the forehead region. The tumor was removed in two stages using the Mohs technique (Figure 2). Nerve tissue was not seen on the Mohs slides. The defect was closed primarily after careful undermining in the upper subcutaneous plane (Figure 3). After surgery the patient had a noticeable ipsilateral brow ptosis. At 1 month follow-up, she complained of heaviness of her left brow. Her vision was not affected. On exam, there was persistent ptosis of the left brow and compensatory elevation of the right brow (Figure 4). Manual elevation of the left brow caused an automatic release of the compensatory brow elevation of the right brow (Figure 5). The patient was unable to return for follow-up. In a phone interview 4 months after surgery, she noted the position of the eyebrows was 90% improved. Discussion