Unusual branching pattern and termination of facial artery and its clinical implications for facial operations

Abstract

The facial artery is the main artery of the face and variations in its origin and its branching pattern have been documented. We report herein multiple facial artery branch variations in the face. A large posterior (premasseteric) branch originated from the left facial artery and coursed upwards behind the main trunk of the facial artery. This artery presented with a straight course and was closely related to the anterior border of the masseter. The branch then terminated by supplying the adjacent connective tissue below the parotid duct. It was also observed that the facial artery was very thick and tortuous and terminated as the superior labial artery. Knowledge of this variation is of great clinical significance in facial operations, especially for maxillofacial surgeons and plastic surgeons, because it forms the anatomical basis for the facial artery musculo-mucosal flap.

The Premasseteric Branch of the Facial Artery: A Review and Translation of Adachi’s Work

“…The facial artery provides the blood supply for a significant portion of the face. The artery originates from the external carotid artery (ECA) and gives off cervical (ascending palatine artery, tonsillar branch, submental artery, and glandular branches) and facial branches (superior and inferior labial branches, lateral nasal branch, and angular artery) anteriorly [6][7][8][9][10].…”

“…Variations exist in which the facial artery produces posterior branches, but these branches often remain unnamed [8].…”

“…The premasseteric, also known as masseteric or posterior, branch of the facial artery is a better known posterior branch that was named as early 1928 by Adachi; however, it has seldom been discussed in the literature (Figure 3) [5]. The premasseteric branch of the facial artery originates in the submandibular region and crosses the ramus of the mandible and travels near the facial vein along the anterior border of the masseter to supply surrounding tissues [5,6,8,[11][12][13]. It is found to divide into superficial and deep branches that usually pierce the masseter and terminate in the region of the parotid duct [6,8,12].…”

“…Typically, this premasseteric branch exists as a single vessel; however, reports have noted the facial artery giving rise to multiple premasseteric branches [7,11]. As a result, knowledge of potential variation is crucial in order to reduce the risk of transection during maxillofacial and plastic surgery procedures such as musculo-mucosal flaps, treatment of facial palsy, benign masseteric hypertrophy, parotid tumor resection, and lower lip repair, to name a few [6,8,11,17,18]. Even for general dentists and oral surgeons, the premasseteric branch might cause bleeding as the facial artery in this area travels near the buccal periosteum in the lower molar region and can be injured during oral surgery [19].…”

“…The artery originates from the external carotid artery (ECA) and gives off cervical (ascending palatine artery, tonsillar branch, submental artery, and glandular branches) and facial branches (superior and inferior labial branches, lateral nasal branch, and angular artery) anteriorly [ 6 - 10 ]. Variations exist in which the facial artery produces posterior branches, but these branches often remain unnamed [ 8 ].…”