Lingual and Facial Artery Fusion: A Cadaveric Report With Clinical Significance

The external carotid artery (ECA) anterior branches, including the superior thyroid, the lingual, and the facial artery (STA, LA, and FA) present variability among cadaveric studies. These arteries may usually originate as isolated branches from the ECA anterior surface and atypically migrate proximally or distally and/or fused into trunks with the most common fusion that of the LA with the FA, into the linguofacial trunk (LFT), and the rarer ones those of the thyrolingual and thyrolinguofacial trunks. The current report describes a case of a bilateral fusion of the LA with the FA into an LFT and another case of a unilateral origin of the FA from the LA (aberrant FA).  In a 75-year-old donated male cadaver, a bilateral symmetrical LFT coexisted with a right-sided STA origin from the ECA proximal origin, at the level of the common carotid artery (CCA) bifurcation. In an 82-year-old donated female cadaver, at the left side, the atypical origin of the FA from the LA proximal origin coexisted with a common trunk of the left CCA with the brachiocephalic artery, and an atypical origin of the STA from the CCA, 3.65 mm inferior to the CCA bifurcation. This report provides a detailed description of the abnormal origin of the ECA anterior branches, the potential fusion of these branches, their exact location, and the existence of an unusual origin proximal or distal to the CCA bifurcation. Aberrant origin and course remain important in surgical and interventional approaches. A thorough understanding of the typical and variable anatomy of the ECA anterior branches ensures safe and successful intervention. Careful preoperative staging and precise dissection are essential components of this process.