Gross anatomical classification of the courses of the human lingual artery

Lingual artery: Angiographic anatomy and variations review for neurosurgeons

Background

The lingual artery (LA) is an important branch of the external carotid artery with a distinct course and vascular supply. However, the knowledge of the LA's angiographic anatomy and variation may represent an obscure area for practicing neurosurgeons. Inconsistencies in the origin, shape, three-dimensional orientation, exact course, and branches are key features of the LA, necessitating a better understanding of its detailed angio-anatomical characteristics.

Methods

Summarized key concepts were included based on a review of the literature, including PubMed medical database, focusing on LA anatomy, angiography, and variations.

Results

A focused, high-yield review was provided in this paper, depicting multiple anatomical and angiographic characteristics of the LA based on 20 final identified articles.

Conclusion

Appreciating the LA's anatomy is essential for angiographic interpretation and enhances the precision of related neurovascular procedures.

Lingual Artery Identification for Ligation in Neck Dissection and Transoral Surgery for Oropharyngeal Tumors

OBJECTIVES

Transoral robotic surgery (TORS) and transoral laser microsurgery (TOLM) plus neck dissection are viable alternatives to radiotherapy as a treatment modality in select cases of oropharyngeal squamous cell carcinoma. Many centers advocate for elective ligation of the feeding arteries at index neck dissection prior to TORS/TOLM to mitigate the risk of catastrophic perioperative hemorrhage. Although there are multiple cadaveric studies in the literature to identify the lingual artery at multiple points throughout its course, there are no studies on the intraoperative identification of the lingual artery for elective ligation prior to TORS/TOLM.

METHODS

A retrospective review of all patients undergoing neck dissection with vessel ligation prior to TORS. Lingual artery was identified at its origin, and relation to hypoglossal nerve was recorded. Patient demographics, intraoperative findings including the relation between lingual artery and hypoglossal nerve measured in millimeters, and postoperative complications were extracted from medical records.

RESULTS

Of the 33 cases eligible for this study, the lingual artery was identified directly deep to the hypoglossal nerve in 21 cases (63.6%). Of the remaining cases, seven were within 5 mm inferior to the hypoglossal nerve (21.2%), and only two cases (6.1%) were identified superior to the hypoglossal nerve.

CONCLUSION

The hypoglossal nerve is a useful landmark for the intraoperative identification of the lingual nerve in elective neck dissection prior to TORS. The lingual artery can be identified either immediately deep to or within 5 mm inferior to the hypoglossal nerve in majority of cases.

LEVEL OF EVIDENCE

4 Laryngoscope, 2025.

A comprehensive review of the mental spine

Clinical case reports and research regarding the mental spines and their associated structures create a detailed picture of the floor of the mouth for assessment during clinical treatment. This compilation of information covers the mental spines, the attached geniohyoid and genioglossus muscles, the lingual foramina, and the veins and arteries of the jaw and floor of the mouth. It is important to consider the variations in the mental spines for oral and maxillofacial treatment involving the mandible. Differences in anatomy of the mental spine, including their number, location, and size, can impact diagnosis and treatment approaches.

The Diversity of the Linguofacial Trunk

Background and Objectives: Typically, the external carotid artery (ECA) sends off separate anterior branches: the superior thyroid, lingual, and facial arteries. These could, however, form common trunks: thyrolinguofacial, linguofacial (LFT), or thyrolingual. Although known, the LFT variant was poorly detailed previously, and most authors just counted the variant. We aimed to demonstrate the individual anatomical possibilities of the LFT on a case-by-case basis. Materials and Methods: 150 archived angioCT files were used. After applying inclusion and exclusion criteria, 147 files of 86 males and 61 females were kept for this study. Results: In 34/147 cases, LFTs were found (23.12%). Bilateral LFTs were found in 13/34 cases (38.24%) and unilateral LFTs in 21/34 (61.76%) cases. Forty-seven LFTs were thus identified and further studied for different variables. Regarding the vertical topography of LFT origin, type 1a (suprahyoid and infragonial) was found in 28 LFTs (59.57%), type 1b (suprahyoid and gonial) was found in eight LFTs (17.02%), type 3 (suprahyoid and supragonial) was found in two LFTs (4.25%), type 2 (hyoid level of origin) in eight LFTs (17.02%), and type 3 (infrahyoid origin) in just one LFT (2.12%). Types of the initial course of the LFT were determined: type I, ascending, was found in 22/47 LFTs; type II, descending, in 12/47 LFTs; and type III, transverse, in 13/47 LFTs. Regarding the orientation of the first loop of the LFT, 23/47 LFTs had no loop, 4/47 had anterior loops, 1/47 had a posterior loop, 5/47 had superior loops, 5/47 had inferior loops, and 9/47 had medial loops. The position of the LFT relative to the ECA was classified as medial, anterior, or antero-medial. An amount of 12/47 LFTs were anterior to the ECA, 22/47 were antero-medial, 10/47 were medial, 2/47 were inferior, and 1/47 was lateral. Regarding their general morphology, 23/47 LFTs had a rectilinear course, 22/47 had loops, and 2/47 were coiled. A case-by-case presentation of results further demonstrated the diversity of the LFT. Conclusions: In conclusion, the morphology and topography of the LFT are individually specific and unpredictable. It can be anticipated case-by-case by surgeons on CT or MR angiograms.

Mylohyoid Muscle: Current Understanding for Clinical Management-Part I: Anatomy and Embryology

The mylohyoid is one of the suprahyoid muscles, along with the geniohyoid, digastric, and stylohyoid muscles. It lies between the anterior belly of the digastric muscle inferiorly and the geniohyoid superiorly. In Part I, the anatomy and embryology of the mylohyoid muscle will be reviewed in preparation for the clinical discussion in Part II.

Delineation of Lingual Artery as an Additional Organ-At-Risk for Stereotactic Body Radiation Therapy of Head and Neck Cancers

Lingual artery (LA) stenosis or bleeding can be a potentially fatal consequence of stereotactic body radiation therapy of recurrent head and neck cancer. We aim to provide delineation guidelines for LA contouring during head and neck radiation. Three experienced radiation oncologists and 1 radiologist studied the course of LA and its anatomic relationships. A step-by-step guideline was formulated for its delineation on contrast-enhanced axial computed tomography scans. We recommend that LA should be considered an important organ at risk for stereotactic body radiation therapy of head and neck cancer. Its delineation and dose constraints should be considered on a case-to-case basis.

Harnessing the Forgotten Triangles of the Neck for Lingual Artery Ligation in Glossectomies: A Technical Report

Various geometric structures, such as numerous triangles, are prevalent in the neck. Despite the fact that many of the neck's anatomical triangles have been well documented, others have been almost forgotten about. The repertoire of head and neck cancer surgeons should include an in-depth understanding of these forgotten triangles. This article seeks to contribute valuable information to the existing scientific literature by shedding light on these neglected triangles, which have significant surgical relevance. In this technical report, we provide a detailed description of a technique that employs these neglected triangles to ligate the lingual artery during glossectomies for tongue cancer.

Anatomical Variations in the Origin of the Lingual Artery in the Kenyan Population

Study design

Descriptive cross-sectional study.

Objective

To determine the variations in origin of the LA and its relationship to surgical landmarks.

Background

The Lingual artery (LA) is a branch of the External Carotid Artery (ECA) that constitutes the principal supply to structures within the oral cavity and floor of the mouth. Knowledge of its variant anatomy is therefore vital during radiological and surgical procedures performed in the head and neck region since they may predispose it and other branches of the ECA to iatrogenic injury. There is, however, a dearth of regional data on the same.

Materials and Methods

A total of 70 LA dissections were performed bilaterally on 35 human cadavers. The borders of the carotid triangle were identified after which the external carotid artery and its branches were exposed. The pattern of origin and the diameter of the LA was noted and distances from its origin to the CB, GCHB and the HN were measured. Similar measurements were carried out for any variant trunks. Data was collected and analyzed using SPSS (IBM version 27). A paired t-test was used to compare side differences. Representative photos of the vessel and its variations were taken.

Results

The LA was found to be present in all cadavers dissected and was bilaterally symmetrical in 43% of cases. Four (4) types of branching patterns were encountered in the present study, the most commonly observed being the solitary LA followed by the LFT, TLT and finally the TLFT. The average diameter was least in the solitary pattern and greatest in the TLT. In relation to the CB, the solitary LA originated at a distance of 1.51 ± 0.89 cm while the LFT, TLT and TLFT originated at a distance of 1.80 ± 0.73 cm, 1.02 ± 0.64 cm and 1.25 ± 0.01 cm respectively from the CB. The mean distance from the origin of the LA to the GCHB was least in the TLT and greatest in the TLFT. With reference to the hypoglossal nerve, the LA was at an average, 0.82 ± 0.15 cm from the HN for the solitary pattern, 1.34 ± 0.86 cm for the LFT, 1.34 ± 0.90 cm for the TLT and 1.38 ± 0.93 cm for the TLFT.

Conclusion

The LA in the Kenyan population exhibited a high frequency of variation in comparison to other populations regarding its pattern of origin and relationship to landmarks such as the CB, GCHB and HN. These findings may provide further insight into the understanding of the vascular anatomy to the radiologist and the surgeon to avert complications and improve overall treatment outcome.

The Journey of the Lingual Artery from the Neck to the Oral Cavity: A Cadaveric Study

Study Design

Descriptive cross-sectional.

Objective

The origin of the lingual artery (LA) has been well studied due to its implication in neck dissection, but the course thereafter to the oral cavity is less described. This cadaveric study traced the journey of the LA from the external carotid artery to its terminal branches in the tongue.

Methods

Following bilateral neck dissections in 35 black Kenyan cadavers, the incidence of Beclard's, Lesser's and Pirogoff's triangles, the types of LA origin with its length, relationship to the hyoglossus muscle and anastomosis with other vessels were documented.

Results

Beclard's triangle was found in 64 dissections (91.42%), Lesser's in 46 dissections (65.71%) and Pirogoff's in 39 dissections (55.71%). The LA presented either as a solitary branch (67.15%) or as a branch of either the linguofacial (LFT-24.29%), thyrolingual (TLT-2.72%) or thyrolinguofacial (TLFT-2.86%) trunk. The solitary LA was the longest at 6.93 mm, followed by the TLT branch (6.58 mm), LFT branch (6.12 mm) and TLFT branch (5.65 mm). The majority of solitary LA and LA branches of LFT and TLFT passed through the hyoglossus, while all LA branches of the TLT coursed medial to the muscle. All variants of LA have been found to anastomose with the submental artery (SMA) at frequencies that ranged from 11.10% to 100%.

Conclusions

The LA was found in all cadavers and all Beclards' triangles. There is a significant incidence of LFT and TLFT variants in the Kenyan population. The LA passed either through or medial to the hyoglossus with no lateral relationship being observed.

Variations in the venous supply of the floor of the oral cavity: Assessment of relative hemorrhage risk during surgery

There is little anatomical evidence about the venous plexus in the floor of the oral cavity, although venous injury can elicit late postoperative bleeding after oral surgery and it is difficult to identify the exact location of such an injury. The aim of this study was to assess the relative risk for venous injury during surgery. We investigated the course patterns of the venous plexus in the floor of the oral cavity and analyzed their relationships to those of the arteries using 23 human cadavers (41 halves) in the anatomy course at Niigata University during 2016-2018. The venous plexus in the floor of the oral cavity comprised the perforating submental vein, the vena comitans of the hypoglossal nerve, the vena comitans of the submandibular duct, the vena comitans of the lingual nerve, the sublingual vein, and the deep lingual vein. Individual variations of this plexus include duplications or absences of some veins. There is a high incidence of a submental branch running above the mylohyoid or perforating submental artery in the sublingual fossa among individuals with the perforating submental vein piercing the mylohyoid muscle, whereas the sublingual artery has a high incidence there when there is no perforating submental vein. The course patterns of arteries in the floor of the oral cavity can be predicted by estimating the course patterns of the submental veins. The course patterns of the submental veins or veins associated with the nerves and submandibular duct need to be carefully considered during surgery.

A new landmark for lingual artery identification during transoral surgery: Anatomic-radiologic study

BACKGROUND

A landmark for the identification of the lingual artery (LA) through a transoral perspective can provide surgeons with an easy method to prevent and manage intraoperative bleeding during transoral approach to the base of tongue (BOT).

METHODS

Thirteen tongue and five head and neck specimens were dissected to identify and assess the reliability of the lingual point (LP) as a new landmark for the LA at BOT. The pathway of 42 LAs was radiologically evaluated; axial depth and vertical offset were measured for each LA.

RESULTS

Dissection study: a description of LP is provided; the LA was easily identified in all specimens (36/36 sides) using LP as a landmark. Radiologic study: the mean depth of the LA was 4.2 mm, the mean vertical offset was 1.3 mm.

CONCLUSIONS

LP is a simple and reliable landmark for identification of the LA, potentially helping surgeons to prevent and manage intraoperative bleeding.

Unusual branch of the lingual artery supplies the infrahyoid muscles

Infrahyoid muscles are usually supplied by muscular arteries, originating from the superior and inferior thyroid artery and the internal thoracic artery. In this work, we reported a unilateral anatomical variation of the branching pattern of the lingual artery, which was observed during dissection studies at the University of Brescia. We found an accessory branch arising from the root of the lingual artery that run down medially and supplied the infrahyoid muscles. A similar case has not yet been reported in literature. Considering the current use of the infrahyoid muscles as pedicled myocutaneous flap for reconstructing surgical defects in the head and neck, this vascular variation appears interesting to be reported for appropriate clinical and surgical consideration.

Investigation of the presence and variation of the ascending mental artery: Conventional dissections and ultrasonographic study

BACKGROUND

Tongue and mouth floor infarction following filler injections for chin augmentation is a rare complication that has the increase in incidence been reported.

OBJECTIVE

This study investigated the arterial anastomosis between the submental and sublingual arteries that can lead to the emboli and subsequent tongue infarction during chin augmentation.

METHODS

Forty-two formaldehyde-embalmed cadavers and four soft-embalmed cadavers were dissected to verify the incidence and source of the ascending mental artery. Ultrasonographic study of the artery was performed in 10 healthy volunteers. Attention was paid to discriminate whether the ascending mental artery arose from the submental artery or the sublingual artery using the arch of the mylohyoid muscle as the discriminating landmark.

RESULTS

Incidence of ascending mental artery from the sublingual artery was 7.1% in the studied population. All ascending mental arteries were 0.7 ± 0.2 mm in diameter at the mental protuberance and were branches of the submental artery that arose from the facial artery, except for two arteries that arose from the sublingual artery. Ultrasonographic study revealed that one left and one right sublingual artery from the lingual arteries penetrated the mylohyoid muscle near the midline to become the ascending mental artery in two volunteers. The ascending mental artery from the other side continued from the submental artery.

CONCLUSION

Findings from the cadaveric dissections and ultrasonographic study revealed that the ascending mental artery may be a branch that continues from the lingual artery, or communicates with the sublingual artery through the mouth floor.