Branches of the Maxillary Artery
The maxillary artery is one of the terminal branches of the external carotid artery and supplies deep structures of the face, maxilla, nasal cavity, muscles of mastication, and cranial contents. It is classically divided into three parts based on its relationship to the lateral pterygoid muscle: the first (mandibular) division, second (pterygoid or muscular) division, and third (pterygopalatine) division.
Understanding these branches is essential in oral and maxillofacial surgery due to their relevance in hemorrhage control, nerve blocks, trauma, orthognathic surgery, sinus surgery, and tumor resection.
First Division (Mandibular Portion)
The first division runs posterior to the mandible and is closely associated with the mandibular nerve. Its branches primarily supply the ear, dura, and mandibular structures.
The deep auricular artery supplies the external acoustic meatus and tympanic membrane.
The anterior tympanic artery contributes to the tympanic cavity.
The accessory middle meningeal artery may pass through the foramen ovale and supply the dura mater, often accompanying the mandibular nerve.
The inferior alveolar artery travels with the inferior alveolar nerve through the mandibular canal to supply the mandibular teeth, gingiva, and chin via the mental artery.
The middle meningeal artery is the largest branch of this division and enters the cranial cavity through the foramen spinosum to supply the dura mater; it is clinically significant in epidural hematomas.
Second Division (Pterygoid or Muscular Portion)
The second division supplies the muscles of mastication and adjacent structures. These branches are particularly relevant during orthognathic surgery and procedures involving the infratemporal fossa.
The masseteric artery passes through the mandibular notch to supply the masseter muscle.
The deep temporal arteries (anterior and posterior) supply the temporalis muscle.
The buccal artery supplies the buccinator muscle and cheek.
The medial and lateral pterygoid branches supply their respective muscles of mastication.
Third Division (Pterygopalatine Portion)
The third division enters the pterygopalatine fossa and gives rise to branches that supply the maxilla, nasal cavity, palate, orbit, and upper dentition. These vessels are especially important in sinus surgery, implant placement, epistaxis management, and maxillary trauma.
The pharyngeal artery supplies the nasopharynx and auditory tube.
The infraorbital artery travels through the infraorbital canal to supply the orbit, midface, and upper lip, also giving rise to anterior superior alveolar branches.
The descending palatine artery divides into the greater and lesser palatine arteries, supplying the hard and soft palate.
The artery of the pterygoid canal (Vidian artery) supplies the upper pharynx and auditory tube.
The posterior superior alveolar artery supplies the maxillary molar and premolar teeth, maxillary sinus, and posterior alveolar bone.
The sphenopalatine artery is the terminal branch of the maxillary artery and a major contributor to the nasal septum and lateral nasal wall; it is the most common source of posterior epistaxis.
Clinical Relevance
Knowledge of the maxillary artery and its branches is critical for avoiding intraoperative bleeding, managing facial trauma, performing nerve blocks, and treating epistaxis. The close anatomical relationship between these vessels and cranial nerves makes precise surgical planning essential, particularly in the infratemporal and pterygopalatine regions.
