Surg Radiol Anat (2006) 28: 248253

DOI 10.1007/s00276-006-0094-z

O R I GI N A L A R T IC L E

Yelda Atamaz Pinar Figen Govsa

Anatomy of the superficial temporal artery and its branches:

its importance for surgery

Received: 5 May 2005 / Accepted: 12 January 2006 / Published online: 28 March 2006

Springer-Verlag 2006

Abstract The temporoparietal, parieto-occipital aps or

the forehead aps that are used in reconstructive surgery
are prepared on the supercial temporal artery (STA)
and its branches. For a successful surgery and a suitable
ap design, adequate anatomical knowledge is needed.
In our study, the red colored latex solution was injected
into the external carotid artery; the STA and its branches were dissected in 27 specimens. The mean diameter
of the STA at the zygomatic arch was determined as
2.730.51 mm. The diameters of the frontal branch
were bigger than those of the parietal branch in 15
samples out of 27. The diameters of both the frontal and
parietal branches were equal in four samples. The
diameter of the parietal branch was bigger than that of
the frontal branch in eight samples. In 20 samples out of
27 (74.07%), the bifurcation point of the STA was above
the arch. In six samples (22.22%), the STA bifurcated
directly over the arch. In only one sample (3.70%),
bifurcation was not observed and the STA continued
only as a frontal branch (absence of the parietal branch).
The absence of the frontal branch was not encountered.
In one sample (3.70%), double parietal branches were
observed. In six samples out of 27 (22.22%), zygomatico-orbital artery was not encountered. In 21 samples
(77.77%), zygomatico-orbital arteries ran towards the
face, parallel to zygomatic arch and distributed in the
orbicularis oculi muscle. The transverse facial artery
existed in all samples. The auricular branches running to
the helix and tragus were observed in all samples. The
STA was 16.680.35 mm at the front of the tragus.
Some landmarks were chosen on the head and then the
STA was observed where it crossed all of these landmarks. This paper conrms the well-known variability
of the supercial temporal arterial branches and their
Y. A. Pinar (&) F. Govsa
Department of Anatomy, Medical Faculty,
Ege University, 35100
Bornova, Izmir, Turkey
E-mail: yeldap@hotmail.com
Tel.: +90-232-3903366
Fax: +90-232-3393546

relation to the pericranial region. Knowledge concerning

the arterial features of the lateral forehead region is
important for the aesthetic surgeon. STA and its branches have been found to be suitable for use in microvascular anastomoses. A better understanding of the
midline forehead vascularity should allow modication
of reconstructive techniques and reduce postoperative
complications.
Keywords Supercial temporal artery Anatomy
Flap

Introduction
The supercial temporal artery (STA) is one of the
terminal branches of the external carotid artery. It
begins in the parotid gland behind the mandible and
crosses the posterior root of the zygomatic process of the
temporal bone [1, 4, 9, 12, 16]. Then, above the zygomatic process, it divides into an anterior frontal and a
posterior parietal branch [5, 15, 18, 19].
The STA supplies the face and scalp together with
some branches of the external carotid artery. As the face
is an aesthetic region, its deformation should be repaired
with the most suitable tissue. The scalp is popular
because it is suitable and near the face [1, 3, 8, 10]. For
this reason, knowing that the STA and its branches
supply the scalp and anastomose with the other arteries
is important.
The temporoparietal, parieto-occipital or the forehead aps that are used in reconstructive surgery are
prepared on the STA and its branches. It has been
reported that these aps are used for the treatment of
baldness and for the recovery of the defect of face and
scalp [3, 7, 14, 21]. In addition, the distance between the
STA and tragus is important for designing the preauricular aps [13]. The STA or its branches are also used
as an interposed artery graft for extracranial to intracranial vascular anastomoses [2, 6, 17, 20].

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Several anatomic studies have described in detail the

diameter of the STA, however, without detailed
description of its topoanatomic relations to the temporoparietal and parieto occipital regions. It is necessary to
be familiar with the variations in the course of the STA
and its branches for the evaluation and treatment of
certain aesthetic problems, especially those of ap
surgery on the lateral forehead region.

Materials and methods

A total of 14 adult cadavers (13 men and 1 woman) that
had been xed in a 10% formalin solution, with 27
supercial temporal arteries were dissected at the
Department of Anatomy, Faculty of Medicine, Ege
University. The age range of the cadavers was
4375 years. After the red colored latex solution was
injected into the external carotid artery, the STA and its
branches were dissected under 2.5 loupe magnications.
The STA was traced in reference to the surrounding
landmarks, including the tragus, zygomatic arch and
lateral canthus. The position of the bifurcation of the
supercial temporal artery into its two terminal branches relative to the arch was noted. In the course of the
dissection of each region, the arteries encountered as
well as their origin, position, branches, course and
anatomical relations were carefully noted.
The diameters of the STA at the level of the zygomatic arch and the diameters of the terminal branches at
the point 1 cm from bifurcation were measured [19]. The
caliber of the STA, the frontal branch, and the parietal
branch were measured with a digital caliper (0.02 mm
Shock & Proof). The frontal branch and the parietal
branch were investigated according to Marano [12]. The
temporal and zygomatic branches of facial nerve were
dissected.
Some landmarks were chosen on the head: the middle
point to the bony lateral canthus (A), the tragus (B), the
superior attachment of the ear to the head (C), and the
point 2 cm directly above this attachment (D). These
points were joined to the bony lateral canthus by
straight lines: AB, AC, and AD. The DF line, which
takes Juris original ap as a base, begins at the point
2 cm above the ear, and is directed anterosuperiorly 45
above the AD line to the anterior hair line. The F point

Table 1 Measurements of STA

and its branches (P>0.005)
Diameter STA
Diameter frontal branch
Diameter parietal branch
Line AB
Line AC
Line II-C
Line AD
Line DF

Fig. 1 The course of the STA and its branches. We used some
landmarks on the head (A, B, C, D, F points). Straight lines joined
these points (AB, AC and AD). Line DF, according to Juris
original ap, begins at the point 2 cm above the ear, and is directed
anterosuperiorly 45 above line AD to the anterior hairline. The F
point was over the anterior hairline. The course of the STA and its
branches were dened according to these lines and points.
Bifurcation of the STA above the zygomatic arch

was over the anterior hairline. It was checked whether

the parietal branch passed the DF line. According to
Juris design, the DF line builds the base of parietooccipital aps, and parietal branch has to take place in
the ap. This ap has been improved for surgical
treatment of baldness [4, 19], (Fig. 1). The STA was then
observed where it crossed all these lines [4, 12, 19]. To
the data gathered as a result of measurements, Student t
test was applied for statistical analysis.

Mean (extremes)

Right side

Left side

2.730.51 mm (1.823.70)
2.140.54 mm (1.203.70)
1.810.45 mm (1.12.75)
80.075.14 mm (6587)
81.765.29 mm (66.288)
20.010.54 mm
83.624.66 mm (7290)
11.047.75 mm (233.3)

2.660.58
2.130.57 mm
1.760.52 mm
80.384.09 mm
81.955.44 mm

2.700.44 mm
2.140.54 mm
1.840.40 mm
79.746.23 mm
81.565.35 mm

85.173.47 mm
11.658.31 mm

82.035.33 mm
10.437.43 mm

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Results
The diameters of the STA at the level of the zygomatic
arch and the diameters of the terminal branches at the
point 1 cm from bifurcation were measured. The mean
diameter of the STA at the zygomatic arch was
determined as 2.730.51 mm. It was determined
as 2.140.54 mm for the frontal branch, and as
1.810.45 mm for the parietal branch. The measurements of STA and its branches have been given in
Table 1. There were no signicant dierences between
the vessel diameters of the right and left sides in any
subject (P>0.05).
The diameters of the frontal branch were bigger than
those of the parietal branch in 15 samples out of 27
(Fig. 2). The diameters of both the frontal and parietal
branches were equal in 4 samples out of 27 (Fig. 3). The
diameters of the parietal branch were bigger than those
of the frontal branch in eight samples. In 6 out of 27
(22.22%), the diameters of the parietal branch were
thinner than 1.5 mm. The samples with a diameter of
less 1.5 mm were dened as thin parietal branches.
Three of these six samples were observed on the left side,

Fig. 2 Bifurcation of the STA over the zygomatic arch (white

arrow). The diameter of the frontal branch was bigger than that of
the parietal branch. rf Frontal branch, rp parietal branch, tfa
transverse facial artery

and the other three on the right. In 3 samples out of 27

(11.11%), thin frontal branch was encountered. Thin
STA was not observed.
In 20 samples out of 27 (74.07%), the bifurcation
points of the STA were above the zygomatic arch
(Figs. 1, 3). In 6 out of 27 (22.22%), the STA bifurcated
directly over the arch (Fig. 2). In only one sample
(3.70%), bifurcation was not observed, and the STA
continued only as a frontal branch at the temporal region (absence of parietal branch). In this sample, subbranches coursing to the back of the frontal branch
supplied the parietal region. The absence of the frontal
branch was not observed. In one sample (3.70%), double parietal branches were encountered.
In all samples, the parietal branch went forward to
the parietal tuber as the continuation of the STA. They
anastomosed with the opposite parietal branch on the
epicranial aponeurosis. Its subbranches coursing towards the front anastomosed with the frontal branch at
the temporoparietal region. Its subbranches going
backwards anastomosed with the posterior auricular
artery and occipital artery at the back of the head. Its
perforating branches passed the deep fascia (Figs. 2, 4).

Fig. 3 Bifurcation of the STA above the zygomatic arch (white

arrow). rf Frontal branch, rp parietal branch, za zygomatico-orbital
artery, tfa transverse facial artery; black arrows: anterior auricular
arteries

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the STA was over the arch (22.22%). The artery going to
the lobule of the auricle was seen in only 10 samples
(37.03%). The helical artery anastomosed with the posterior auricular artery by its subbranches (Figs. 1, 2, 3).
AB line

Fig. 4 Distribution of the parietal branch. Anastomoses between

the parietal branch and the occipital artery. rp Parietal branch, oa
occipital artery

The frontal branch went forward to the front of the

head, parallel to the upper corner of the orbicularis oculi
muscle. While it went to the frontal muscle, it came back
to galea. The frontal branch anastomosed with the
opposite frontal branch on the galea, with supraorbital
and supratrochlear arteries at the forehead, and with the
zygomatico-orbital artery around the orbit and the
forehead. Its perforating branches passed the deep fascia
and the frontal muscle (Figs. 1, 2, 3).
In 6 samples out of 27 (22.22%), the zygomaticoorbital artery was not observed. In these samples, the
terminal branches of the transverse facial artery and
many small subbranches of the STA or the frontal
branch came to the lateral region of the orbit (Figs. 2,
5). In 21 samples (77.77%), the zygomatico-orbital artery ran towards the face parallel to the zygomatic arch,
and it distributed in the orbicularis oculi muscle. It was
observed that the zygomatico-orbital artery anastomosed with the transverse facial artery and the frontal
branch along its course. The zygomatico-orbital artery
arose from the frontal branch in samples where the
bifurcation point of the STA was over the zygomatic
arch (22.22%), (Figs. 2, 3, 5).
The middle temporal artery existed in all samples.
However, its course could not be observed, as the deep
fascia was not lifted. The course of the transverse facial
artery was observed after the supercial part of the
parotid gland was dissected. The transverse facial artery
existed in all samples and arose from the STA. It was
seen that its branches going to the parotid gland and the
cheek anastomosed with the facial artery and zygomatico-orbital artery on the masseteric fascia (Figs. 1, 2, 5).
The anterior auricular arteries had a diameter of
1 mm or less. These branches running to the helix and
tragus were observed in all samples. They reached the
helix passing under the supercial temporal vein at the
level of the arch. The helical artery arose from the parietal branch in samples in where the bifurcation point of

AB line was measured as mean 80.075.14 mm,

80.384.09 mm on the right, and, 79.746.23 mm on
the left. The STA was 16.680.35 mm at the front of
the B point on line AB, as 16.853.34 mm on the
right, and 16.503.52 on the left (I point). In other
words, the STA went 16.680.35 mm at the front of the
tragus at the level of arch (I-B line). Juris design to STA
and the terminal branches have been summarized in
Table 1. There were no signicant dierences between
the lengths of the right and left sides in any subject
(P>0.05).
AC line
AC line was measured as mean 81.765.29 mm in all
samples, 81.955.44 mm on the right, and,

Fig. 5 Anastomoses between the transverse facial artery and the

facial artery. tfa transverse facial artery, fa facial artery, mm
masseter muscle

252

81.565.35 mm on the left. Juris design to STA and the

terminal branches have been summarized in Table 1.
There were no signicant dierences between the lengths
of the right and left sides in any subject (P>0.05).
II-C line
II-C line was measured as 20.010.54 mm in all samples. The course of the STA was determined according
to I-B ve II-C distances (Fig. 1). Juris design to STA
and the terminal branches have been listed in Table 1.
There were no signicant dierences between the lengths
of the right and left sides in any subject (P>0.05).
AD line
AD line was measured as mean 83.624.66 mm,
85.173.47 mm on the right, and 82.035.33 mm on
the left. Juris design to STA and the terminal branches
have been given in Table 1. There were no signicant
dierences between the lengths of the right and left sides
in any subject (P>0.05).
The parietal branch passed 11.047.75 mm at the
front of the D point over the DF line in 26 samples out
of 27 as 11.658.31 mm on the right, and,
10.437.43 mm on the left (Fig. 1). There were no signicant dierences between the lengths of the right and
left sides in any subject (P>0.05).

Discussion
Microsurgical procedures in the treatment of lateral
forehead region disorders demand detailed description
of all pericranial structures [1, 4, 7, 14, 17, 21]. Many
authors have published anatomical studies of the STA
and its distribution area [1, 4, 9, 12, 15, 19]. For a successful surgery and a suitable ap design, adequate
anatomical knowledge is necessary. When the ap is
raised at the temporoparietal area, the aesthetic defect is
minimized because the hair covers the donor site.
Table 2 Bifurcation point of the STA in literature
Position of the
bifurcation point
of the STA
according to authors

Above the
zygomatic
arch (%)

Over the
zygomatic
arch (%)

Below the
zygomatic
arch (%)

Stock [19]
Marano [12]
Abul-Hassan [1]
Czerwinski [5]
Chen [4]
Magden [11]
Sahinoglu [16]
Strauch [18]
Atamaz Pinar

60
88
80
62.5
86.5
80
61
80
74.07

32
4

26
3.8
10
14

22.22

8
4

11.5
9.6
8
7

Therefore, it is suitable as a donor site for ap, and

preferred by surgeons [3, 8, 14, 21].
The STA is very important by itself. It supplies blood
to half of the parotid gland, the posterior half of the
temporo-maxillary joint, the entire horizontal portion of
the scalp and the entire upper lateral half of the face.
It has been reported that the diameters of the vessels
measured have all mean ranges for the STA as
2.032.14 mm [1, 4, 9, 11, 19], the frontal branch
as 1.612.1 mm [4, 9, 11], and the parietal branch as
1.442.1 mm [4, 9, 11]. In various researchers studies,
the bifurcation point of the STA observed above the
zygomatic arch has ranged between in 61 and 88% of
the cases [1, 4, 11, 14], directly over the arch between 3.8
and 26% [4, 5, 11, 16, 19], and below the arch between 7
and 11.5% [4, 5, 11, 16].
According to Marano, the diameters less than 1 mm
are accepted as atrophic. The atrophic frontal branch is
present in 2%, either the parietal branch or the frontal
branch was atrophic in 4%, the atrophic STA was
present in 2% and the double parietal branches were
present in 4% [12].
Stock et al. [19] used Juris design to dene the STA and
its terminal branches. They found the IB distance as
0.94 cm, IIC distance as 1.39 cm and the, D-parietal
branch distance as 1.54 cm [19]. The distances according to
Juris ap design were found as: AB line, 82.401.09 mm,
CB line, 81.81.34 mm, and D-parietal branch distance
13.50.22 mm [4]. Later, Stock et al. improved Juris ap
design. They made a rotation to the ap to include the
parietal branch according to the anterior hairline and the
course of the parietal branch. As to their opinion, the
exible ap was much more sensible than the routine design [19].
Chang et al. performed total upper lip reconstruction
with a free temporal scalp ap. They marked the STA
using light palpation at the preoperation stage [3]. Lopez
et al. [15] used the temporal fasciocutaneous island ap,
which was supplied by the parietal branch for oncologic
oral and facial reconstruction. Ricbourg et al. investigated the zygomatico-orbital artery. According to their
denition, the zygomatico-orbital artery branched as
type I, out of the STA in 80% of the cases and it
branched as type II, out of the frontal branch where
bifurcation point of the STA was over the arch in 20%
of the cases [15].
We have compared some of our results with those of
the researchers in Tables 2 and 3. We have observed that
our ndings are generally compatible with those of the
others. In our study, specimens were studied to determine the suitability of the supercial temporal artery for
use in microvascular anastomoses. The mean diameter
of the STA at the zygomatic arch was determined as
2.730.51 mm. Bifurcation points of the STA were
above the zygomatic arch in 74.07% specimens. One
specimen (3.7%) had no bifurcation, and 67% had at
least one branch, which was 1.5 mm in the frontal or
parietal distribution. A suitable frontal branch
(i.e., 1 mm in diameter) was found in 89% of the

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Table 3 Diameters of the STA,
frontal branch and parietal
branch (mm)

Authors

STA

Frontal branch

Parietal branch

Stock [19] (radiological)

Stock [19] (cadaveric)
Marano[12]
Abul-Hassan [1]
Chen [4]
Magden [11]
Strauch [18]
Atamaz Pinar

1.890.68
2.030.33
2.2 (15)
1.82.7
2.140.45
2.9 (24.1)
1.82.7
2.730.51 (1.823.7)

1.380.4
1.740.51

1.610.19
2.1 (0.83.1)

2.140.54 (1.23.7)

1.290.5
1.830.34

1.680.21
2.1 (0.93.1)

1.810.45 (1.12.75)

specimens and a suitable parietal branch was found in

78%. Although one specimen (3.7%) had a double
parietal branch, the diameters of all branches were of
suitable size. The zygomatico-orbital artery was observed to be coursing towards the face, parallel to the
zygomatic arch in 77.77% of the cases. The successful
usage of the forehead and parieto-occipital ap depends
on the anatomical features of the pedicles of the parietal
and frontal branches contained. Racial dierences of the
supercial temporal artery distribution were observed. If
this vessel needed to be palpated, this was felt to be a
good point of reference to start with.
This paper conrms the well-known variability of the
STA and its arterial branches, and their relation to the
pericranial region. Their arterial distribution is clinically
important. The advancement of new methods provides
increased possibilities for studying the arterial circulations in the temporoparietal and parieto-occipital
regions, thus emphasizing the importance of detailed
knowledge about the anatomical variations in these
areas. Operations on the lateral forehead region can
severely damage some of the branches as well as the
main trunk of the STA. Since variations in blood
supplies of the lateral forehead region have been
observed during our cadaveric study, we believe that the
existence and course of the STA and its branches should
be preoperatively conrmed by Doppler examination,
and during dissection, great care should be taken so as
not to damage the vascular pedicles.

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