The variability of the facial artery in its branching pattern and termination point and its relevance in craniofacial surgery

Background It is believed that by classifying the branching patterns of the facial artery, surgeons will have a better understanding of arterial distribution across the face, resulting in a greater success rate with regards to facial reconstructive surgery using this vessel. However, there is still a dispute within the literature as to how the facial artery should be classified. The purpose of this study was to identify the branching pattern and termination point of the facial artery and to establish if these classifications corresponded to those in the literature. Methods The facial artery was dissected in 21 adult embalmed Caucasian cadavers. A superficial pre-auricular incision was made in the coronal plane anterior to the auricle, extending from the tragus to approximately the mid-point on the sternocleidomastoid muscle. The skin and platysma were retracted anteriorly to expose the facial artery. Results Twenty-five different arterial branching patterns and six main termination points over 40 facial arteries were found. Some of the patterns found correlated with those described within the literature, whilst many were unique to this investigation. Conclusions The wide variation in the branching pattern and termination point of the facial artery demonstrates the difficulty in producing classification patterns for this vessel. It also raises the question on the usefulness of producing classification patterns. With the increasing use of pre-operative imaging and planning, coupled with meticulous dissection of every branch of the artery intra-operatively, it may have no clinical relevance producing many sub-classification patterns of arterial variation.