Double ascending pharyngeal artery: the first evidence

Area of Science:

• Anatomy
• Vascular Surgery
• Radiology

Background:

• The ascending pharyngeal artery (APA) is a branch of the external carotid artery (ECA).
• Variations in APA origin are known, but double or duplicated APAs have not been previously documented.
• Understanding these variations is crucial for surgical procedures in the head and neck region.

Purpose of the Study:

• To report the first documented cases of double and two-rooted ascending pharyngeal arteries (APAs).
• To describe the specific anatomical characteristics of these rare variations.
• To emphasize the clinical significance of these findings for surgical safety.

Main Methods:

• Retrospective review of archived angioCT imaging data from two adult male patients.
• Detailed analysis of the origin, course, and branching patterns of the ascending pharyngeal arteries.
• Comparison with existing anatomical literature on APA variations.

Main Results:

• Case 1: A double APA on the right side with superior and inferior origins from the ECA. The left APA, lingual, and facial arteries had infrahyoid origins.
• Case 2: Two roots of the left APA originating from the ECA above the greater hyoid horn, with an anastomosis to the ascending palatine artery.
• These findings represent the first documented evidence of double and partly duplicated APAs.

Conclusions:

• The existence of double and two-rooted APAs is confirmed, representing significant anatomical variations.
• These variations necessitate increased vigilance during surgical interventions near the external carotid artery (ECA) and the greater hyoid horn.
• Surgeons should be aware of potential infrahyoid origins and unusual courses of arteries typically expected to arise higher up.