A cadaveric study quantifying the anatomical landmarks of the facial artery and its parapharyngeal branches for safe transoral surgery

Background Hemorrhage remains a major potential risk when performing any form of transoral surgery. This is the first study to focus on the location of the facial artery "bulb" (FaB) and its tonsillar branches within the parapharyngeal space (PPS) from the perspective of the transoral surgeon. Method A total of 44 hemi-sections were dissected via the transoral approach with endoscopic assistance: 26 from fresh-frozen specimens and 18 formalin-fixed hemi-sections. The distance from the superior apex of the FaB to the pterygoid hamulus (PH) was recorded, and the arterial branching variations described. Results The average distance from the PH to the FaB was 4.17 +/- 0.4 cm. In 90.9% of cases, the two tonsillar artery branches passed between styloglossus muscle (SGM) and stylopharyngeus muscle (SPM). Conclusion Understanding the FaB location and its branching patterns offers the surgeon confidence dissecting in the PPS transorally.