Unilateral double facial artery: an anatomic variant and clinical implications

Abstract

Background: This paper reports a rare anatomical variant of the facial artery (FA) - namely, a double FA pattern - which has significant implications in a wide range of surgical and aesthetic medicine disciplines.

Case: The study involves a case report and literature review of the FA and its variants. The case is that of a 61-year-old female cadaver with a unilateral FA variant branching pattern discovered during a cadaveric dissection for an anatomy course.

Discussion: The dissection revealed an unusual supply of the typical FA distribution by two separate branches from either side of the maxillary artery. The first branch, termed FA1, followed a typical FA course arising from the external carotid to supply the lower portion of the face via lingual, inferior labial, and mental arterial branches. The second branch, termed FA2, arose superior to the maxillary artery near the origin of a typical transverse facial artery, to supply the upper portion of the face via superior labial, lateral nasal, and angular arterial branches. No direct communication between the two branches was observed grossly via dissection. The observed branching pattern has not previously been reported in literature and has critical implications for surgical planning and intervention.

Conclusion: This study emphasizes the importance of understanding variant FA anatomy in procedures requiring precise anatomical knowledge of arterial supply to the face. Duplicate and/or secondary facial arteries necessitate careful consideration for their potential consequences on the success of surgery of the head and neck, dermal fillers, and embolization for epistaxis procedures.

Keywords: Facial artery; filler; musculomucosal flap; reconstructive surgery.

Figure 1.

(a) Initial view of a right anomalous facial artery before skin removal, coursing horizontally across the face. Branches of the facial nerve are visible immediately surrounding the artery. (b) Further dissection demonstrated two facial arteries from the external carotid artery (ECA).

Figure 2.

(a) The proximal end of ECA gives rise to a common trunk (CT), which divides into FA1 and lingual artery (LA). FA1 later gives off mental artery (MeA). The distal end of ECA gives rise to a trifurcation of MA, FA2, and STA. The superior thyroid artery (SThA) is also identified. (b) Figure 2(a) with arteries outlined in red.

Figure 3.

(a) FA2 Runs transversely across the cheek to give branches to the superior labial artery (SLA) and lateral nasal artery (LNA). FA1 gives rise to MeA, which gives rise to the inferior labial artery (ILA). (b) Figure 3(a) with arteries outlined in red.

Figure 4.

Measurements: FA1, MA, FA2, and STA branch from ECA. The diameter of ECA is 8 mm proximally, 7 mm after FA1 takeoff, and 5 mm after MA takeoff. As ECA terminates as STA, the diameter is 3 mm. The diameters of FA1, MA, and FA2 are 3, 5, and 6 mm, respectively. The distance between the takeoffs of FA1 and MA is 37 mm, and the distance between the takeoffs of MA and FA2 is 9 mm.

Figure 5.

Normal facial artery branches from ECA and courses around the inferior border of the mandible before branching into the superior and inferior labial arteries, and LNA. FA, via LNA, ultimately terminates as AA at the medial canthus of the eye. Image source: [1].