Double ascending pharyngeal artery: the first evidence.

Most studies of the ascending pharyngeal artery (APA) observed its different possibilities of origin. No evidence had been previously presented of either double or partly duplicated APAs. The anatomic variants reported here were found during the retrospective review of archived angioCT imaging data from two adult males, both aged 65 years. In the first case, a double APA was found on the right side. The inferior APA and a linguofacial trunk had infrahyoid origins from the external carotid artery (ECA) and coursed over the greater horn of the hyoid. The superior APA had a suprahyoid origin from the ECA. On the left side, the APA, lingual, and facial arteries had infrahyoid origins and ascended on the inner side of the greater hyoid horn. In Case #2, there were two roots of the left APA, leaving the ECA above the greater hyoid horn. An anastomotic branch united the APA and the ascending palatine artery. A superiorly looped long sternocleidomastoid branch left the ECA proximally to the origin of the lingual artery. We brought here the first convincing evidence of double and, respectively, two-rooted (partly duplicated) APAs. These possibilities warrant caution during open-field surgeries. Care should be taken to the arteries expected to originate from the ECA at a distance from the greater hyoid horn because they can have infrahyoid origins and may course over or under this surgical landmark.