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Ascending pharyngeal artery

The ascending pharyngeal artery (APA) is the smallest but one of the most important branches of the external carotid artery, supplying deep structures of the pharynx and skull base. Despite its small caliber, it provides critical vascular supply to the pharyngeal wall, prevertebral muscles, auditory tube, upper cervical vertebrae, dura mater, and cranial nerves passing through the jugular foramen and hypoglossal canal.

The APA has two major divisions—pharyngeal and neuromeningeal—that ascend vertically along the pharyngeal wall and skull base. Because of its deep and medial location, it serves as a key artery in head and neck vascular anatomy and is an essential landmark in skull base imaging.

Synonyms

  • Arteria pharyngea ascendens

  • Ascending branch of the external carotid artery

Origin, Course, and Termination

  • Origin: Arises from the posterior aspect of the external carotid artery, typically near the carotid bifurcation.

  • Course:

    • Ascends vertically between the pharynx medially and the styloid process/lateral musculature laterally.

    • Travels deep to the styloglossus, stylopharyngeus, and stylohyoid muscles.

    • Reaches the base of the skull, giving branches to the dura and cranial nerve canals.

  • Termination: Divides into the pharyngeal branch (to pharyngeal mucosa and prevertebral tissues) and the neuromeningeal branch (into the jugular and hypoglossal canals).

Relations

  • Medially: Pharyngeal wall, constrictor muscles

  • Laterally: Styloid apparatus, external carotid artery, internal carotid artery

  • Anteriorly: Stylopharyngeus and pharyngeal musculature

  • Posteriorly: Longus capitis, prevertebral fascia

  • Superiorly: Jugular foramen, hypoglossal canal

Branches

  • Pharyngeal branch: Supplies pharynx, auditory tube, and prevertebral musculature

  • Neuromeningeal trunk:

    • Jugular branch: Supplies dura of posterior fossa via jugular foramen

    • Hypoglossal branch: Supplies dura via hypoglossal canal

  • Muscular branches: To longus capitis and superior constrictors

  • Tympanic branches: Small branches to the middle ear

Function

  • Provides arterial supply to the pharynx, upper cervical vertebrae, prevertebral muscles, and cranial nerve sheath regions

  • Supports meningeal circulation through skull base foramina

  • Contributes to vascular networks of the auditory tube and posterior cranial fossa dura

  • Serves as a major deep cervical artery in the pharyngobasilar and neuromeningeal territories

MRI Appearance

T1-weighted images

  • The artery appears as a small, tubular flow void (dark structure).

  • Surrounding soft tissues show intermediate signal intensity.

  • The vertical ascending course along the pharyngeal wall may be faintly seen due to adjacent fat planes.

T2-weighted images

  • Flowing blood produces a dark flow void, similar to T1.

  • The vessel wall remains low signal.

  • Adjacent pharyngeal soft tissues are intermediate-to-bright depending on composition.

STIR

  • The artery remains dark due to flow void.

  • Surrounding fat is suppressed, allowing better contrast between the artery and pharyngeal musculature.

  • Soft-tissue fascial planes along the pharyngeal wall become more distinct.

T1 Fat-Saturated Post-Contrast

  • The Ascending Pharyngeal Artery shows strong, uniform arterial enhancement.

  • Its vertical course can be traced clearly from the external carotid artery upward to the skull base.

  • Enhancing branches passing toward the jugular foramen and hypoglossal canal are better visualized with high-resolution fat-sat imaging.

CT Appearance

Non-Contrast CT

  • The artery is not distinctly visible except as a small soft-tissue density near the pharyngeal wall.

  • The surrounding bony structures of the skull base (jugular foramen, hypoglossal canal, clivus) are well depicted.

  • Fat planes around the pharyngeal region help infer the artery’s position indirectly.

Post-Contrast CT

  • The artery becomes a small, enhancing linear vessel ascending between the pharyngeal wall and styloid apparatus.

  • The pharyngeal and neuromeningeal branches enhance along the skull base.

MRI image

Ascending pharyngeal artery mri axial iamge