Temporal Artery Ligation

Q: Dr. Eppley, I am a middle-aged male and I recently noticed that I have bulging temporal arteries (can feel a pulse) on both temples, which look like squiggly worms from my ear arcing up to my (receding) hairline. These arteries are visible at rest but really ‘pop’ when I get hot, drink alcohol, or workout. I did not have these (or at least they were not noticeable enough) several months ago. I went to a Rheumatologist, who ruled out GCA/temporal arteritis. I am now exploring options to reduce the visibility of these, one of which is arterial ligation and I have a few questions:
1) In lieu of GCA/temporal arteritis, what causes the temporal artery to suddenly swell and become permanently visible (I’ve read about others who have experienced the same thing)?
2. How many of these temporal artery ligations have you performed? How many needed follow-up procedures?
3. My biggest fear by far with this procedure is damaging the facial nerve, which from pictures I’ve seen, runs extremely close to the temporal artery. I know plastic surgeons study where the nerves are but I assume the location of the facial nerve differs in everyone. Any damage to this nerve would becatastrophic and would be 100x worse than the bulging temporal arteries. How would you respond to this?
4. How do you ‘map’ these arteries to determine if there are ‘feeder branches’ that would circumvent the ligation – do you use some type of ultrasound?
5. Could ligating the temporal arteries cause the arteries that run from the eye to the hairline (or other facial arteries) to swell and turn into the ‘squiggly worms’ (I read about a guy who this happened to 3 years after he got a temporal artery ligation).
6. Which arteries would supply the scalp / forehead if the temporal arteries no longer function?
7. Does the temporal artery supply blood to anything else (besides the scalp / forehead)
8. How big are the incisions? \I’ve read that dissolving stitches leave a bigger scar than removable stitches – is this true?
9. Do you tie off the arteries or sever them? I read that you don’t drain them – how does that remove the bulging effect as the blood would be trapped within the temporal arteries (I picture a water balloon – you can tie off the end but all that does is trap the water in, making the balloon swell).
10. I assume it is local anesthesia, correct?
11. What is the recovery time? What is expected post-op as far as swelling / bruising / scarring / time until return to work / exercise / etc?
12. Do you perform this procedure on Saturdays for out-of-towners?

A: In answer to your temporal artery ligation questions:

  1. It is unknown.
  2. I have performed over 50 temporal artery ligation v]cases which has resulted in about 10% to 15% needing a touchup for additional ligations.
  3. The frontal branch of the facial nerve is not in the same areas as the ligation points
  4. Visual and digital assessment is the method used to map out the arterial patterns.
  5. This is not something I have seen. With multipoint ligation this risk is lowered significantly.
  6. There are many other arteries that supply the scalp.
  7. No.
  8. 5 to 6mms for the incisions size. Dissolveable sutures do not leave a bigger scar.
  9. The arteries are double tied but not cut. The blood is stripped between the ligation points to prevent postoperative bulging.
  10. Local anesthesia is correct.
  11. There is very minimal recovery time, no real recovery actually
  12. I only operate during the weekdays.

Dr. Barry Eppley
Indianapolis, Indiana