Cutting the conjoint tendon (temporal fusion line)
Richard C. Allen, MD, PhD, FACS
Additional Notes: Length 03:00
This video demonstrates lysing of the conjoint tendon or temporal fusion line in a patient undergoing a small incision browplasty without an endoscope. Usually, surgeons will use an endoscope during this step of the operation. In this case, the endoscope is not used and dissection planes are demonstrated. An incision is made temporally with a 15 blade to straddle the conjoint tendon that has been marked preoperatively. Dissection is then bluntly carried out with Metzenbaum scissors lateral to the conjoint tendon to the level of the deep temporalis fascia. Metzenbaum scissors and then used to slide along the surface of the deep temporalis fascia to the superior lateral orbital rim. A Freer periosteal elevator is then used to dissect medial to the conjoint tendon to the subperiosteal plane. The Metzenbaum scissors and then reintroduced to lyse the conjoint tendon between the medial subperiosteal dissection plane and the lateral dissection plane along the surface of the deep temporalis fascia. The scissors are used to feel each side of the conjoint tendon and then lyse between these 2 planes. In this procedure, dissection was carried out from the upper eyelid incision to the superior orbital rim. Once the conjoint tendon has been lysed, a free plane is demonstrated. Again, this is demonstrated on the contralateral side. The 15 blade is used to make an incision through the skin and subcutaneous fat. Dissection is then carried out bluntly with Metzenbaum scissors through the superficial temporalis fascia to the deep temporalis fascia. The Metzenbaum scissors again are used to bluntly dissect and slide along the surface of the deep temporalis fascia. This is performed to the lateral superior orbital rim. The Freer periosteal elevator is then used to dissect to the subperiosteal plane medial to the conjoint tendon. The Metzenbaum scissors and then used to lyse the conjoint tendon between these 2 dissection planes. With experience, this procedure can be performed easily without the need for an endoscope.
