Case Reports in Plastic Surgery & Hand Surgery · Published 2026-05-11 · DOI 10.1080/23320885.2026.2664264
Niccolò Fagni, Ferdinando Paternostro, Guglielmo Maria Fiori, Ludovica Livi, Giorgio Zinno, Jacopo Junio Valerio Branca, Eugenio Bertelli, Immacolata Belviso
Variations in the branching pattern of the facial artery may affect the planning and outcome of reconstructive and aesthetic procedures in the midface. Here, we report a rare anatomical variant in which the facial artery trifurcates early into three distinct branches, including a novel buccinator branch. In January 2025, the right-sided facial artery of a 67-year-old male Caucasian cadaver, injected with colored acrylic resins, was dissected at the ICLO Teaching and Research Center (Verona, Italy). Following identification of the external carotid artery, the facial artery was traced via an oblique submandibular approach. Branching patterns were documented through digital photography and schematic illustration. Instead of the classical singular course, the facial artery formed a common trunk that, 2 cm distal to its origin, trifurcated within a 1 cm span along the inferior mandibular margin. The anteromedial branch followed the standard facial artery trajectory; the posterolateral (premasseteric) branch supplied the masseteric region; and the central (buccinator) branch penetrated the buccinator fascia, arborizing extensively within the muscle belly. This buccinator branch exhibited a markedly dense microvascular network not previously described. This variant expands the known spectrum of facial arterial anatomy. While the direct clinical impact of a single observation remains limited, awareness of such configurations may be relevant in selected surgical contexts, particularly in flap planning and in procedures involving the buccal region. Unlike the classical buccal artery arising from the internal maxillary system, this branch originated directly from the facial artery and appeared to provide predominant intramuscular vascularization of the buccinator. Further bilateral cadaveric and imaging studies are necessary to determine the prevalence and clinical relevance of this and related anatomical configurations.
Abstract from DOAJ. Public domain (CC0 1.0).
Read the article at the publisher →
Fagni, N., Paternostro, F., Fiori, G., et al. (2026). Early trifurcation of the facial artery including a dedicated buccinator branch: anatomical and surgical implications. Case Reports in Plastic Surgery & Hand Surgery. https://doi.org/10.1080/23320885.2026.2664264