Anatomy, Head and Neck, Ascending Palatine Artery

The ascending palatine artery's location passes between the styloglossus and the stylopharyngeus muscles where it later makes its way into the levator veli palatine muscle. This artery provides blood to the musculus uvulae, palatoglossus, palatopharyngeus, and the levator veli palatine muscles.[1][2] However, the palatopharyngeus muscle receives the majority of its blood supply from the ascending pharyngeal artery.[6]

The presence of anterior and posterior branches of the ascending palatine artery differs between individuals. The anterior branch alone is expected to arise in 25% of people, the posterior alone is found 35% of the time, as where both anterior and posterior branches together are found in 40% of people.[1] The ascending palatine artery branches from the facial artery in 67% of individuals, with rare cases of the artery arising from the external carotid artery.[7][8] 

Osteotomies of the Le Fort l segment

Osteotomies of the Le Fort l segment are common surgeries that are known to have low complication rates. The main complication includes ischemia which leads to avascular bone necrosis of the Le Fort l segment, which is rare. When completing this surgery, it is important to note that the ascending palatine artery, along with the ascending pharyngeal artery, are the main, and most common, blood supplies to the area.[9] However, the absence of the ascending palatine artery occurs in 10% of patients, leading to an increased risk of hypoperfusion and avascular necrosis.[9]

 Complications due to physiologic variations

When the anterior and posterior branches of the ascending palatine artery are not present simultaneously, there can be differences in surgical risks. When the ascending branch is non-existent, and the posterior branch terminates close to the uvula, there is an increased risk of damaging the main blood supply to the soft palate.[1]

 Cleft palate repair

Knowledge of the soft palates arterial supply is important for surgical procedures of velopharyngeal incompetence and cleft palate. Cleft palates result in the arteries of the soft palate being displaced anterior-laterally due to the bone and muscle deformities.[10] It is suggested to dissect around the hamulus to avoid damage to the ascending palatine artery, which provides the main blood supply to the soft palate, ascending pharyngeal artery and the recurrent pharyngeal arteries.[2],[10] By dissecting around the hamulus, there is the prevention of wound break down, muscular fibrosis, and flap failure.[10]

 Treatment of recurrent hemorrhage after tonsillectomy

After a tonsillectomy bleeding from the lodge is a rare complication, occurring in approximately 3% of all patients.[11] This bleeding occurs due to a pseudoaneurysm of the tonsillar branch of the ascending palatine artery. Usually, reoperation or pharmacologic treatment is effective in stopping the bleed; however, in severe cases, endovascular therapy is the primary treatment.[11] The selective embolization of the ascending palatine artery is the best method for stopping a severe bleed.[11]

Hard palate necrosis after ascending palatine artery embolization

This procedure is a standard treatment used for refractory epistaxis is embolization. The embolization of the ascending palatine artery can result in unilateral necrosis of the mucosa that is superficial to the hard palate.[12] Surgical debridement alongside antibiotics and analgesic can be used to treat the necrosis of the tissue of the hard palate.[12]

The ascending palatine artery is not well researched and therefore requires more attention to gain further understanding of its function, physiological variations, clinical significance, and surgical considerations.