Arterial Supply of the Mouth - Lingual Artery

Diagrams

Origin and Course

1. Forms an upward loop then passes deep to the hyoglossus muscle
2. Passes through the oropharyngeal triangle (bounded by mylohyoid, superior constrictor, and middle constrictor muscles)
3. Enters the floor of the oral cavity
4. Runs forward between the hyoglossus and genioglossus muscles toward the tongue apex

Branches of the Lingual Artery

• Scott-Brown's Otorhinolaryngology Head & Neck Surgery, p. 683

Structures Supplied by the Lingual Artery

• Tongue (principal artery - all parts)
• Sublingual gland
• Gingiva (lingual gingival surface of mandibular teeth)
• Oral mucosa of the floor of the oral cavity
• Soft palate and palatine tonsil (via dorsal lingual branches)
• Epiglottis (inferior epiglottic branches)

Additional Contributions to the Mouth/Root of Tongue

• Tonsillar and ascending palatine branches of the facial artery
• Ascending pharyngeal artery branches (root of tongue)
• Superior laryngeal artery epiglottic branches (anastomose with inferior dorsal lingual branches in the vallecula region)
• Scott-Brown's Otorhinolaryngology Head & Neck Surgery, p. 683

Arterial Supply of the Mouth - Facial Artery

Diagrams

Origin and Course

1. Arises from the external carotid artery, passes deep to the digastric and stylohyoid muscles
2. Passes through (or deep to) the submandibular gland, giving off glandular branches
3. Hooks over the inferior border of the mandible just anterior to the masseter (pulse palpable here)
4. Enters the face, runs in a tortuous upward and medial course - deep to platysma, risorius, and zygomaticus; superficial to buccinator and levator anguli oris
5. Passes lateral to the angle of the mouth giving off labial branches
6. Ascends along the side of the nose
7. Terminates as the angular artery at the medial canthus of the eye

• Gray's Anatomy for Students, p. 7257

Branches of the Facial Artery

Cervical Branches (given off in the neck)

Facial Branches (given off on the face - relevant to the mouth)

• Gray's Anatomy for Students, p. 7264, 7275-7283; K.J. Lee's Essential Otolaryngology

Key Points for the Mouth Specifically

• Lips: The superior and inferior labial arteries are the principal supply. They form a labial arterial arcade around the lips by anastomosing with their counterparts from the opposite side. This rich anastomosis means lip lacerations bleed profusely but heal well.
• Labial gingiva (anterior): Supplied by the mental artery (branch of inferior alveolar), which also receives perforating branches from the incisive artery; labial branches of the infraorbital artery supply the upper labial gingiva.
• Tonsil and soft palate: Via the tonsillar and ascending palatine cervical branches.
• The labial branches anastomose across the midline, providing an important link between the facial arteries of both sides (and thus between both external carotid arteries). - Scott-Brown's Otorhinolaryngology Head & Neck Surgery, p. 681

Mnemonic for Branches

• Cervical: Ascending palatine, Tonsillar, Glandular, Submental
• Facial: Inferior labial, Superior labial, Lateral nasal, Angular

• Origin from the external carotid artery in the neck
• Course past the submandibular gland, deep to digastric and stylohyoid, hooking over the mandible anterior to the masseter
• Submental artery running along the underside of the jaw above mylohyoid
• Inferior and superior labial arteries at the angle of the mouth
• Lateral nasal artery up the side of the nose
• Angular artery as the terminal branch at the medial corner of the eye

Arterial Supply of the Mouth - Maxillary Artery

Diagrams

Origin and Course

• Gray's Anatomy for Students, p. 2440-2442

Branches Relevant to the Mouth

From the 1st Part (Mandibular)

From the 2nd Part (Pterygoid)

From the 3rd Part (Pterygopalatine) - Most Important for Mouth

• Gray's Anatomy for Students, p. 2771-2781; Scott-Brown's Otorhinolaryngology, p. 681-683

Summary: Maxillary Artery Supply to Each Part of the Mouth

• Scott-Brown's Otorhinolaryngology Head & Neck Surgery, p. 681-683; Gray's Anatomy for Students, p. 2766

Pterygopalatine Fossa - 3rd Part of the Maxillary Artery

Diagrams

What is the Pterygopalatine Fossa?

• Middle cranial fossa - via foramen rotundum (maxillary nerve V2) and pterygoid canal
• Infratemporal fossa - via pterygomaxillary fissure (entry of maxillary artery)
• Floor of orbit - via inferior orbital fissure (infra-orbital artery/nerve)
• Lateral nasal cavity - via sphenopalatine foramen (sphenopalatine artery)
• Hard palate/oral cavity - via greater/lesser palatine canals
• Nasopharynx - via palatovaginal canal (pharyngeal branch)

3rd Part of the Maxillary Artery - The 6 Branches

1. Posterior Superior Alveolar Artery (PSA)

• Origin: Given off as the maxillary artery passes through the pterygomaxillary fissure (just before entering the fossa)
• Course: Descends on the posterolateral surface of the maxilla; enters through alveolar foramina
• Supply: Upper molar and premolar teeth, adjacent gingiva, maxillary sinus

2. Infra-orbital Artery

• Course: Exits fossa through inferior orbital fissure → runs in infra-orbital groove and canal → exits at infra-orbital foramen
• Supply:
  • Anterior superior alveolar arteries (branch within infra-orbital canal) → upper incisor and canine teeth + maxillary sinus
  • Inferior rectus and inferior oblique muscles, lacrimal sac (orbital floor structures)
  • Face below orbit (skin of cheek, lower eyelid)
• Note: A middle superior alveolar artery (when present) also arises from this vessel to supply upper premolars

3. Greater Palatine Artery

• Course: Descends with palatine nerves through palatine canal; exits at greater palatine foramen; runs forward on inferior surface of hard palate to incisive fossa; ascends through incisive canal
• Supply:
  • Hard palate (mucosa and glands)
  • Palatal gingiva of all upper teeth
  • Anterior nasal septum (via incisive canal - anastomoses with nasopalatine/sphenopalatine artery = Kiesselbach's plexus/Little's area)

4. Lesser Palatine Artery

• Origin: Branch of the greater palatine artery within the palatine canal
• Course: Exits through lesser palatine foramen
• Supply: Soft palate, palatine tonsil

5. Pharyngeal Artery

• Course: Passes posteriorly through palatovaginal canal (with pharyngeal nerve of V2)
• Supply: Posterior roof of nasal cavity, sphenoidal sinus, pharyngotympanic (Eustachian) tube, nasopharynx

6. Sphenopalatine Artery (Terminal Branch)

• Course: Exits medially through sphenopalatine foramen into nasal cavity
• Supply:
  • Posterior lateral nasal arteries → lateral wall of nasal cavity, paranasal sinuses
  • Posterior septal branches → nasal septum; largest branch descends septum anteriorly to anastomose with greater palatine artery at incisive fossa

7. Artery of Pterygoid Canal (Vidian Artery)

• Course: Passes posteriorly through pterygoid canal (with nerve of pterygoid canal/Vidian nerve); terminates in nasopharyngeal mucosa via cartilage of foramen lacerum
• Supply: Pharyngotympanic tube, upper nasopharynx, middle ear

Summary Table

• Gray's Anatomy for Students, p. 2755-2793; Scott-Brown's Otorhinolaryngology, p. 681-683

Clinical Note

1st Part of the Maxillary Artery (Mandibular Part)

Diagrams

Location and Relations

• Laterally: Neck/ramus of the mandible
• Medially: Sphenomandibular ligament

5 Branches of the 1st Part

1. Deep Auricular Artery

• Course: Ascends superiorly toward the temporomandibular joint (TMJ)
• Supply: External acoustic meatus (skin lining), outer surface of the tympanic membrane
• Small branch; passes through or near the parotid tissue

2. Anterior Tympanic Artery

• Course: Passes through the petrotympanic fissure
• Supply: Inner (deep) surface of the tympanic membrane; mucosa of the middle ear (tympanic cavity)
• Anastomoses with the stylomastoid branch of the posterior auricular artery

3. Middle Meningeal Artery (Largest and Most Important)

• Course: Ascends vertically → passes between the two roots of the auriculotemporal nerve → enters cranial cavity through foramen spinosum; divides into anterior and posterior branches within the dura
• Supply: Largest meningeal artery; supplies dura mater, cranial bone and bone marrow of the lateral cranial wall
• Clinical: Torn by a blow to the pterion (thinnest part of skull) → extradural (epidural) hematoma. Anterior branch most commonly injured. CT shows biconvex/lenticular hyperdense collection.

4. Accessory Meningeal Artery

• Course: Passes through foramen ovale (alongside V3/mandibular nerve)
• Supply: Cranial dura mater (accessory supply), trigeminal ganglion (Gasserian ganglion), walls of the cavernous sinus
• Also gives small branches to the infratemporal fossa structures (pterygoid muscles, tensor veli palatini)

5. Inferior Alveolar Artery (Major Branch)

• Course: Descends with the inferior alveolar nerve (V3) → enters mandibular foramen → traverses the mandibular canal → gives off:
  • Dental branches to all lower molar/premolar teeth
  • Incisive branch (terminal) → lower incisors and canines; continues to midline
  • Mental artery → exits mental foramen → supplies chin, lower lip, labial gingiva
• Before entering mandible: gives off mylohyoid branch → supplies mylohyoid muscle and anterior belly of digastric
• Supply: All lower teeth, mandibular bone, lower labial gingiva, chin, mental region

Summary Table

• Gray's Anatomy for Students, p. 2449-2476

Key Clinical Points

2nd Part of the Maxillary Artery (Pterygoid / Muscular Part)

Diagrams

Location and Relations

• Branches of the mandibular nerve [V3] (lingual, inferior alveolar, buccal, deep temporal nerves)
• The pterygoid venous plexus
• Medial and lateral pterygoid muscles

4-5 Branches of the 2nd Part

1. Anterior Deep Temporal Artery

• Course: Ascends between the temporalis muscle and the pericranium (periosteum of temporal fossa)
• Accompanies: Anterior deep temporal nerve (V3)
• Supply: Temporalis muscle (anterior part)
• Also sends a small branch through the zygomatico-orbital foramen to the orbit

2. Posterior Deep Temporal Artery

• Course: Also ascends between temporalis and pericranium (posterior to the anterior branch)
• Accompanies: Posterior deep temporal nerve (V3)
• Supply: Temporalis muscle (posterior part)
• Together, both deep temporal arteries are the principal blood supply of the temporalis muscle

3. Pterygoid Branches (multiple)

• Course: Multiple small branches to both medial and lateral pterygoid muscles
• Supply: Medial pterygoid and lateral pterygoid muscles (muscles of mastication)
• These do not have named nerve companions but follow pterygoid muscle planes

4. Masseteric Artery

• Course: Passes laterally through the mandibular notch (sigmoid notch) between the coronoid process and neck of condyle
• Accompanies: Masseteric nerve (V3)
• Supply: Masseter muscle (deep surface); also supplies the TMJ joint

5. Buccal Artery

• Course: Passes forward and downward between the two heads of the lateral pterygoid → runs with the buccal nerve (V3) to reach the cheek
• Supply: Buccinator muscle, buccal mucosa and skin of the cheek, buccal gingiva (posterior lower teeth)
• Anastomoses with the facial artery and infraorbital artery - important collateral connection

Summary Table

• Gray's Anatomy for Students, p. 2479-2485; Color Atlas of Human Anatomy Vol. 2, p. 93

Key Points

• The 2nd part is the "muscular part" - all branches supply muscles of mastication or adjacent soft tissue
• No branch passes through a bony foramen (a key distinguishing feature from parts 1 and 3)
• The buccal artery is the only branch with relevance to oral mucosa
• The deep temporal arteries are important in temporal arteritis and in temporal muscle flap surgery
• The pterygoid venous plexus surrounding this part has communications with the cavernous sinus via emissary veins through the foramen ovale - a route for spreading dental infections intracranially - Gray's Anatomy for Students, p. 2501