The ascending pharyngeal artery: branches, anastomoses, and clinical significance

Abstract

Neuroradiologists generally do not fully appreciate the importance of the territory of the ascending pharyngeal artery. The ascending pharyngeal artery is a small but important artery that supplies multiple cranial nerves and anastomotic channels to the anterior and posterior cerebral circulations. Several disease processes in the head and neck involve the ascending pharyngeal artery. To evaluate and treat such diseases, it is necessary for neuroradiologists not only to know selective angiography and embolization techniques, but also the territory of the ascending pharyngeal artery, anastomoses, and vascular supply to the vasa nervorum of lower cranial nerves. Herein, the normal angiographic anatomy of the ascending pharyngeal artery, its relationship with neighboring territories, its importance in clinical situations, and research models are reviewed.

Fig 1.

A and B, Anteroposterior (A) and lateral (B) angiograms depict rare instances of the ascending pharyngeal artery arising from the internal carotid artery.

Fig 2.

Diagram of the two major trunks of the ascending pharyngeal artery: anteriorly, the extracranial pharyngeal trunk; posteriorly, the neuromeningeal trunk, which is intracranial and enters the posterior fossa through the foramen magnum.

Fig 3.

Angiogram (A) and diagram (B) of the superior, middle, and inferior pharyngeal branches supplying the pharyngeal submucosal spaces.

Fig 4.

Diagram of the lateral view of the hypoglossal and jugular branches, the two main divisions of the neuromeningeal trunk. Top, superior view; bottom, inferior view; left, anterior view; right, posterior view.

Fig 5.

View from above the hypoglossal and jugular branches. Top, superior view; bottom, inferior view; left, anterior view; right, posterior view.

Fig 6.

Angiogram (A) and diagram (B) of the odontoid arch system that gives rise to several branches that supply the first, second and third cervical roots and the periosteum of the spinous processes and pedicles. Top, superior view; bottom, inferior view; left, anterior view; right, posterior view.

Fig 7.

Angiogram (A) and diagram (B) of the inferior tympanic artery arising as a separate branch between the pharyngeal and neuropharyngeal trunks. Top, superior view; bottom, inferior view; left, anterior view; right, posterior view.

Fig 8.

Diagram depicting ascending pharyngeal artery anastomoses.

Fig 9.

Angiogram (A) and diagram (B) of the ascending pharyngeal artery communication with the internal carotid artery to the lateral clival branch of the jugular artery.

Fig 10.

Angiogram (A) and diagram (B) of the ascending pharyngeal artery anastomoses to the vertebral artery via the hypoglossal branch and musculospinal branch. Top, superior view; bottom, inferior view; left, anterior view; right, posterior view.

Fig 11.

Angiogram (A) and diagram (B) of anastomoses to the occipital artery via the odontoid arch. Top, superior view; bottom, inferior view; left, anterior view; right, posterior view.

Fig 12.

Angiogram (A) and diagram (B) of C1-C2 anastomoses to the occipital artery via the common trunk. Top, superior view; bottom, inferior view; left, anterior view; right, posterior view.

Fig 13.

Angiogram (A) and diagram (B) of anastomoses via the pterygovaginal artery to the accessory meningeal artery. Top, superior view; bottom, inferior view; left, anterior view; right, posterior view.

Fig 14.

Angiogram (A) and diagram (B) of the ascending pharyngeal artery supplying a meningioma. Top, superior view; bottom, inferior view; left, anterior view; right, posterior view.

Fig 15.

Angiogram (A) and diagram (B) of the ascending pharyngeal artery supplying a glomus jugulare tumor. Top, superior view; bottom, inferior view; left, anterior view; right, posterior view.