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The facial artery

The facial artery supplies the muscles and skin of
the face. It has a crucial function in maintaining
these areas, and provides them with oxygen and
nutrients. The facial artery is one of the eight
branches of the external carotid artery.

Course and Relations

The common carotid artery is the first branch of
brachiocephalic trunk on the right side, and the
first branch of the arch of the aorta on the left
side. It travels superiorly, and divides into the
external and internal carotid arteries at the
superior border of the thyroid cartilage. The
internal carotid continues to pass upwards, and
passes into the skull via the carotid canal. The
artery then passes forwards to enter the cavernous
sinus, and makes a 180 degrees turn back on itself
and emerges lateral to the optic chiasm. The
internal carotid artery then trifurcates into the
middle cerebral, anterior cerebral and posterior
communicating arteries, which supply various
regions of the brain.
The external carotid passes upwards and
superficially and gives off a number of branches
to the face, and scalp. These are the superior
thyroid artery (supplies the thyroid gland in the
neck), the lingual artery (supplies the tongue),
ascending pharyngeal artery (supplies the
pharynx), facial artery (supplies the facial
muscles, skin and part of the scalp), occipital
artery (supplies the posterior scalp), posterior
auricular artery (the scalp behind the ear as well
as the ear itself), maxillary artery (the deep
structures of the face) and finally the

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superficial temporal artery (the scalp in the

temporal region). The facial artery also known as
the external maxillary artery arises from the
anterior surface of external carotid, and has a
tortuous route along the nasolabial fold towards
the medial canthus of the eye. It moves beneath
the digastric and stylohyoid muscles and it will
pass through the submandibular gland.
The artery will then curve over the body of the
mandible (deep to platysma), as the anteroinferior
angle of the masseter, will ascend forwards and
upwards across the cheek, to the angle of the
mouth and along the side of the nose. It
terminates near the medial aspect of the eye. In
the region of the head, the facial artery runs
roughly parallel to the facial vein, although not
adjacent to it.

Cervical Branches
Ascending Palatine Artery- This artery passed
superiorly between the styloglossus and
stylopharyngeus. It divides close to the levator
veli palatini muscle into two branches. One branch
pierces the superior pharyngeal constrictor, in
order the reach the auditory tube and the palatine
tonsil. It will then anastomose with the ascending
pharyngeal artery as well as the tonsillar branch
of the facial artery. The other branch runs with
the levator veli palatini and passes over the
superior pharyngeal constrictor in order to supply
the soft palate, finally anastomosing with the
maxillary artery (the descending palatine branch).
Tonsillar Branch- This branch ascends between
styloglossus and the medial pterygoid muscle,
before piercing the superior pharyngeal
constrictor to reach the palatine tonsil.

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Submental artery- This branch runs on the inferior

aspect of the chin. This is the largest of the
cervical branches of the facial artery. The branch
is given off just as the facial artery passes
through the submandibular gland. The vessel passes
anteriorly on top of the mylohyoid muscle, beneath
the digastric muscle and just inferior to the body
of the mandible. The artery supplies the muscle
surrounding this region, and anastomoses with the
sublingual artery as well as the inferior alveolar
artery (the mylohyoid branch). The submental
vessels supply the skin over the submental area.
The submental artery also divides into the
superficial and deep branch. The superficial
branch anastomoses with the inferior labial
artery. The deep branch also anastomoses with the
inferior labial artery as well as the mental
branch of the inferior alveolar artery.
Glandular Branches- These are 3-4 large branches
that supply the submandibular salivary gland, as
well as some structures that are found nearby i.e.
the lymph nodes and integument.

Facial Branches
Inferior Labial artery- This branch of the facial
artery arises close to the corner (angle) of the
mouth. It then passes superiorly and forwards in
order to run beneath the triangularis (depressor
anguli oris) muscle and pierces the orbicularis
oris muscle. It supplies the mucous membrane and
muscles of the lower lip and also supplies the
labial glands. The vessel anastomoses with the
artery of the opposite side and inferior alveolar
artery (the mental branch).

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Superior Labial artery- This a significantly

larger and more tortuous branch of the facial
artery when compared to the inferior labial
artery. It supplies the upper lip and also gives a
few branches that ascend to supply and nasal
septum and ala of the nose.
Lateral nasal branch - This branch of the facial
artery ascends along the lateral aspect of the
nose. It supplies numerous structures, including
the dorsum of the nose, the ala, and anastomoses
with its contralateral fellow, the infraorbital
branch of the internal maxillary artery as well as
the dorsal nasal branch of the ophthalmic artery.
Angular artery (the terminal branch)- This is the
final and terminal branch of the facial artery. On
the cheek the artery supplies the lacrimal sac and
orbicularis oculi and ultimately anastomoses with
the ophthalmic artery (the dorsal nasal branch).
It also ascends toward the medial angle of the
orbit, and lies within the fibers of the quadratus
labii superioris (a broad sheet of muscle that
arises from the lateral aspect of the nose to the
zygomatic bone). The terminal portion ultimately
finishes at the medial canthus of the eye. It is
accompanied by the greater occipital nerve, that
innervates the scalp and provides sensation.

Clinical Points
Palpation- Anaesthetists palpate the facial artery against the
anteroinferior angle of the masseter muscle against the bony
surface of the mandible.
Carotid Artery Vascular disease- Atherosclerosis (vascular
disease) of the common carotid artery (commonly at its
bifurcation) increases the risk of emboli shooting off and hence
strokes occurring. Transient ischaemic attacks (a stroke where the
symptoms resolve in less than 24 hours) are also more likely to
occur. Treatment includes carotid endarterectomy, or endovascular
treatment of the disease.

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The maxillary artery

The maxillary artery is one of the two terminal
divisions of the external carotid artery. The
second terminal branch is the superficial temporal
artery. Therefore the maxillary artery can be
defined as one of the continuations of the
external carotid artery, and distributes the blood
flow to the upper (maxilla) and lower (mandible)
jaw bones, deep facial areas, cerebral dura mater
and the nasal cavity. Hence it is considered a
blood vessel which supports both hard and soft
tissues in the maxillofacial region.
The main trunk of the maxillary artery is divided
into three parts which are named according to
related structures along the arterys course (path
of travel). These three parts are the:
1 Mandibular part (1st part) named as such
because it winds around deep to the neck of
the mandible,
2 Pterygoid part (2nd part) it has this name
because it travels between the two heads of
the lateral pterygoid muscle,
3 Pterygopalatine part (3rd part) this part
derived its name from the pterygopalatine
fossa, into which it enters.
Conventionally, these three parts are described as
the part before-, part on-, and part beyond the
lateral pterygoid muscle. This is also useful
since out of the 15 branches of the maxillary
artery, the 5 branches from the second part (part
on the lateral pterygoid muscle) are regarded as
branches to soft tissues and they DO NOT course
through foramina in bones. However, the remaining
10 branches, from the first and third parts, go
through foramina in bones.

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Course
The maxillary artery continues as one of the
terminal divisions of the external carotid artery
at the level of the neck of the mandible (Fig. 2)
and passes forwards between the neck of the
mandible and the sphenomandibular ligament. It
continues its path by running deeply to the lower
head and passes forward between the two heads of
the lateral pterygoid muscle to break into its
terminal branches at the pterygopalatine fossa.

Branches & Distribution

The main trunk of the maxillary artery extends
into the following fifteen branches, which can be
remembered using the mnemonic:

DAMn I AM Piss Drunk But Stupid Drunk I

Prefer, Must Phone Alcoholics Anonymous
Based on that mnemonic, the order of the branches
and their distributions is the following:

a. from mandibular part

D deep auricular artery: this branch runs
upwards to enter the ear and courses superficially
to the tympanic membrane, passing between the
cartilage and bone to supply blood to the external
acoustic meatus of the ear
A anterior tympanic artery: this is the second
branch that courses near the tympanic membrane. It
passes deep to the membrane, through the
petrotympanic fissure to the middle ear to join
the circular anastomosis around the tympanic
membrane
M middle meningeal artery: this one passes
straight upwards through the foramen spinosum to
join the two roots of the auriculotemporal nerve.

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It supplies bones of the skull (calvaria) and the

dura mater
I inferior alveolar artery: runs downwards and
forwards towards the inferior alveolar nerve, to
meet the nerve at the mandibular foramen. The
artery runs further anteriorly in the mandible,
supplying the pulps of the mandibular teeth (with
its dental branches) and the body of the mandible.
Its other branch, the mental branch, emerges from
the mental foramen and supplies the nearby lip and
skin
A accessory meningeal artery: this branch is the
chief source of blood supply to the trigeminal
ganglion. It passes upwards through the foramen
ovale to supply the dura mater of the floor of the
middle fossa and of the trigeminal cave (Meckels
cave)

b. from pterygoid part (all of which

supply only soft tissues)
M masseteric artery: accompanies the lingual
nerve. It is small, and passes laterally through
the mandibular notch to the deep surface of the
masseter muscle, which it supplies
P pterygoid artery: this artery varies in its
number according to Authors. However, it supplies
the lateral pterygoid muscle and medial pterygoid
muscle
D deep temporal artery: this branch bifurcates
into two - anterior and posterior, and course
between the temporalis and the pericranium
respectively, supplying the muscles, and
anastomose with the middle temporal artery. The
anterior division communicates with the lacrimal
artery by means of small branches which perforate
the zygomatic bone and great wing of the sphenoid

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B buccal or buccinator artery: runs obliquely

forward, between the pterygoideus internus and the
insertion of the temporalis muscle, to the outer
surface of the buccinator muscles, to which it
supplies, anastomosing with branches of the facial
artery and with the infraorbital artery. From the
infraorbital area, the buccal artery descends
bilaterally in the superficial face along the
lateral margin of the nose, then running antiparallel to the facial artery across the lateral
oral region

c. from pterygopalatine part

S sphenopalatine artery:supplies the nasal
cavity; it is also called Nasopalatine artery. It
passes through the sphenopalatine foramen into the
cavity of the nose, at the back part of the
superior meatus. Here it gives off its posterior
lateral nasal branches. Crossing the inferior
surface of the sphenoid, the sphenopalatine artery
ends on the nasal septum as the posterior septal
branches
D descending palatine artery: this divides to
form the greater and lesser palatine arteries to
supply the hard palate and soft palate
respectively. It descends through the greater
palatine canal with the greater and lesser
palatine branches of the pterygopalatine ganglion,
and emerging from the greater palatine foramen,
runs forward in a groove on the medial side of the
alveolar border of the hard palate to the incisive
canal; the terminal branch of the artery passes
upward through this canal to anastomose with the
sphenopalatine artery
I infraorbital artery: passes forwards through
the inferior orbital fissure, along the floor of

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the orbit and infraorbital canal to emerge with

the infraorbital nerve on the face
P posterior superior alveolar artery: supplies
the maxillary teeth. Gives branches that accompany
the corresponding nerves through foramina in the
posterior wall of the maxilla
M - middle superior alveolar artery (branch of the
infraorbital artery)
P pharyngeal artery:supplies structures such as
the pharynx androof of the nose.
A - anterior superior alveolar artery (branch of
the infraorbital artery)
A artery of the pterygoid canal: runs into the
pterygoid canal. It passes backwards along the
pterygoid canal with the corresponding nerve. It
supplies the upper part of the pharynx, and sends
a small division into the tympanic cavity to
anastomose with the tympanic arteries.
Clinical Anatomy
Extradural Haematoma: This is also called Epidural haematoma, and
it is the accumulation of blood in the epidural space due to
injury, for example from a road traffic accident or sports injury,
involving the middle meningeal artery. Treatment may require
decompression of the haematoma, usually by craniotomy to ease-out
the pressure cause by the clothed blood on the brain as
illustrated in Fig. 3 below.