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Deep temporal arteries

The deep temporal arteries, comprising the anterior, middle, and posterior branches, are small vessels originating from the second (pterygoid) part of the maxillary artery within the infratemporal fossa.^[1] They ascend superiorly between the temporalis muscle and the pericranium to provide the primary arterial supply to the temporalis muscle, a key masticatory muscle involved in jaw elevation and retraction.^[2] These arteries typically course deep to the temporalis, entering the temporal fossa through its supraperiosteal layer, and may anastomose with branches of the superficial temporal artery for collateral circulation.^[3] In anatomical variations, the deep temporal arteries can number from one to three per side, with the anterior and posterior branches being most consistent, while a middle branch is present in many individuals but may be absent or fused. Their proximity to the bone surface—often less than 2 mm deep—makes them relevant in surgical and aesthetic procedures involving the temple region, such as filler injections, where inadvertent injury could lead to vascular complications.^[4] Additionally, the anterior deep temporal artery communicates with the lacrimal artery through small perforating branches in the zygomatic bone and greater wing of the sphenoid, contributing to orbital vascular networks.^[2] The deep temporal arteries play a crucial role in the vascular supply of the deep facial structures, ensuring adequate perfusion for the temporalis during chewing and other mandibular movements, and their study is essential for understanding infratemporal and temporal fossa anatomy in clinical contexts like maxillofacial surgery.^[1]

Anatomy

Origin and course

The deep temporal arteries consist of anterior, middle, and posterior branches that arise from the second (pterygoid) part of the maxillary artery, which itself is a terminal branch of the external carotid artery. These branches emerge in the infratemporal fossa and initially course superiorly alongside the lateral pterygoid muscle before entering the temporal fossa. Upon entering the temporal fossa, the deep temporal arteries ascend between the temporalis muscle and the temporal bone (deep to the pericranium), passing deep to the temporalis fascia. The anterior deep temporal artery (ADTA) follows a more medial path, while the posterior deep temporal artery (PDTA) takes a more lateral trajectory relative to the vertical plane passing through the zygomatic tubercle. At the level of the zygomatic arch (HZa), the ADTA lies approximately 5.5 mm lateral to this plane, while the PDTA is positioned about 19.4 mm lateral; these distances shift to roughly 2.5 mm for the ADTA and 25.3 mm for the PDTA at the eyebrow level (HEb). Depth from the bone surface decreases superiorly for the ADTA to 1.3 mm at HEb, and remains around 2.0 mm for the PDTA at the same level. The arteries course lateral to the zygomatic process of the temporal bone as they traverse the temporal region. They may briefly anastomose with the middle temporal artery near their superior extent.

Branches and anastomoses

The deep temporal arteries typically comprise anterior, middle, and posterior branches arising from the second part of the maxillary artery within the infratemporal fossa.^[5] The anterior deep temporal artery (ADTA) often gives off small branches that perforate the zygomatic bone and greater wing of the sphenoid bone, facilitating connections to adjacent vascular structures.^[5] These arteries may exhibit multiple smaller offshoots, though the primary anterior and posterior trunks predominate in standard anatomy.^[1] Key anastomoses involve the ADTA linking to the lacrimal artery, a branch of the ophthalmic artery, through these perforating vessels, which supports collateral flow across bony interfaces.^[5] Both the anterior and posterior deep temporal arteries interconnect with the middle temporal artery, derived from the superficial temporal artery, establishing a robust network along the temporal region.^[6] Additionally, the deep temporal arteries contribute to the extracranial-intracranial collateral circulation by providing pathways to the ophthalmic artery and, indirectly, the intracranial vasculature, particularly in cases of carotid occlusion.^[7] In their distribution, the deep temporal arteries ascend between the temporalis muscle and the pericranium, with their branches penetrating the muscle to perfuse its deeper layers.^[5] This pattern ensures targeted vascular supply while maintaining interconnections that enhance regional hemodynamic stability.^[4]

Anatomical variations

The deep temporal arteries typically consist of anterior and posterior branches arising from the maxillary artery, but variations in number occur, with an accessory or middle deep temporal artery present in certain patterns. The middle deep temporal artery is variably present, occurring in many but not all individuals, and may be absent or incorporated into the anterior or posterior branches.^[1] In cadaveric studies, the most common configuration involves the anterior and posterior deep temporal arteries alongside a middle temporal artery from the superficial temporal artery, while a less frequent pattern includes an additional accessory deep temporal artery originating at the level of the coronoid process. A medial temporal artery supplying the upper portion of the temporalis muscle has been observed in approximately 25% of cases. Occasional absence of the anterior deep temporal artery occurs in about 7.1% of sides, often compensated by enhanced branching from the posterior branch.^[8]^[9]^[10] Positional variations are notable, particularly in depth from the temporal bone and lateral deviation within the temporal fossa. The anterior deep temporal artery (ADTA) exhibits a depth ranging from 0.2 to 3.1 mm at the eyebrow level (mean 1.3 ± 0.8 mm), while the posterior deep temporal artery (PDTA) ranges from 0.1 to 5.2 mm at the same level (mean 2.0 ± 1.4 mm). Lateral deviation is more pronounced for the PDTA, with mean distances of 25.3 ± 10.3 mm (range 2.1–41.8 mm) at the eyebrow level, compared to the ADTA's more medial course (up to 14.6 mm). These positions were mapped using horizontal lines at the zygomatico-auricular, temporo-zygomatic, and eyebrow levels in 42 hemifaces, showing no significant differences by sex, side, or ethnicity.^[4]^[11]^[4] Size variations primarily affect vessel diameters, with the ADTA measuring 1.68 ± 0.46 mm on average and the PDTA 1.93 ± 0.50 mm, based on measurements from 19 hemifaces relative to cranial landmarks. Smaller diameters of approximately 0.7 mm (ADTA: 0.7 ± 0.2 mm; PDTA: 0.7 ± 0.1 mm) have been reported in other cadaveric analyses of 28 sides, potentially reflecting sample differences. Rare common trunks, such as one combining the ADTA and infraorbital artery (1.95 mm diameter branching to 1.10 mm ADTA), occur in approximately 5% of cases (1 in 19 hemifaces).^[12]^[10]^[12] Overall prevalence of these variations ranges from 15% to 30% across populations, as inferred from combined studies using cadaveric dissection and imaging, with influences from age and ethnicity noted in ultrasound-based assessments of Asian cohorts where positional shifts were more frontal.^[9]^[8]^[4]

Function

Supply to the temporalis muscle

The deep temporal arteries, consisting of the anterior and posterior branches arising from the maxillary artery, serve as the primary vascular supply to the temporalis muscle, delivering oxygenated blood essential for its role in elevating the mandible during mastication and facilitating head movements. This arterial network penetrates the muscle's deep and superficial layers, forming a dense capillary bed aligned with the muscle fibers to ensure efficient nutrient delivery and waste removal. The temporalis muscle's consistent reliance on these arteries has been documented in anatomical studies, highlighting their critical role in maintaining muscle function without significant contribution from alternative pathways under normal conditions.^[13] The anterior deep temporal artery (ADTA) predominantly supplies the anterior part of the temporalis muscle, accounting for approximately 30% of its muscle mass, while the posterior deep temporal artery (PDTA) perfuses the central part, covering about 51%. The middle temporal artery supplies the occipital and upper parts, accounting for 19%. This segmental distribution ensures comprehensive coverage across the fan-shaped muscle, supporting its viability during sustained contractions. Together with the middle temporal artery, the deep temporal arteries provide a robust framework that adapts to the muscle's biomechanical demands.^[9] These arteries transport high-pressure oxygenated blood to meet the elevated metabolic requirements of the temporalis muscle during chewing, where activity-induced demands can increase local blood flow to support ATP production and prevent fatigue. Anastomoses between the deep temporal arteries and adjacent vessels, such as the middle temporal artery, facilitate even distribution within the muscle.^[14]

Role in collateral circulation

The deep temporal arteries, particularly the anterior branch, play a significant role in collateral circulation by forming anastomoses that link the external carotid artery system—via the maxillary artery—with the internal carotid artery system through branches of the ophthalmic artery.^[15] These connections, including those with the lacrimal and supraorbital arteries, enable retrograde flow to reconstitute the internal carotid circulation in cases of proximal occlusion.^[7] Such pathways are frequently recruited, with the anterior deep temporal artery identified as one of the most common routes for ophthalmic artery-mediated collaterals alongside the middle meningeal artery.^[16] As part of the temporo-orbital collateral network, the deep temporal arteries support cerebral perfusion during conditions like internal carotid artery stenosis or occlusion, where they facilitate alternative blood supply to intracranial structures.^[7] In moyamoya disease, characterized by progressive stenosis of intracranial arteries, these vessels provide essential revascularization to the cerebral hemispheres, enhancing overall hemodynamic resilience.^[17] Physiologically, these anastomoses are crucial for maintaining blood flow to orbital and cranial tissues under hemodynamic stress, thereby mitigating the risk of ischemia in the brain and surrounding regions when primary arterial conduits are compromised.^[18] This collateral function underscores their importance in preserving tissue viability during vascular insults, as evidenced in angiographic studies of occlusive disease.^[7]

Clinical significance

Surgical and procedural considerations

In temple augmentation procedures, a safe zone for deep injections is identified 1 cm posterior to the zygomatic tubercle at the level of the horizontal plane through the zygomatic tubercle (H_Zt), where deep temporal arteries (DTAs) are absent within a 7.2–12.6 mm radius.^[19] Ultrasonography is recommended to map anatomical variations in DTA position and depth prior to injection, as variability can compromise safety.^[19] During temporalis muscle flap surgery for reconstruction of head and neck defects, such as post-maxillectomy or orbital defects, preservation of the anterior and posterior DTA branches is essential to maintain flap viability, as these vessels provide the dominant pedicle supplying approximately 60% of the muscle's blood flow.^[20] Dissection is typically performed in a subperiosteal plane to safeguard these arteries, ensuring 100% flap survival in reported series.^[20] Embolization risks arise in cosmetic filler injections due to potential intravascular entry into DTAs, allowing retrograde flow through anastomoses—such as the zygomaticotemporal artery connecting to the ophthalmic artery—leading to retinal artery occlusion and blindness.^[21] To mitigate this, injections should avoid depths less than 2 mm from the bone at the horizontal plane through the eyebrow (H_Eb), where no safe zone exists owing to wide DTA variability (2.1–17.2 mm posterior to the vertical plane).^[19]^[22] In general temporal region surgeries, such as pterional craniotomies, dissection planes deep to the temporalis muscle—often subperiosteal—minimize bleeding by avoiding direct injury to the DTAs while preserving muscle integrity and reducing postoperative atrophy.^[23]

Associated pathologies

In Moyamoya disease, a progressive cerebrovascular disorder characterized by stenosis of the internal carotid arteries, the deep temporal arteries (DTAs) play a critical role in providing collateral blood supply to the cerebral hemispheres through anastomoses with intracranial vessels, such as the middle meningeal artery and transdural pathways, thereby aiding in revascularization and mitigating ischemic events.^[16] This collateral function is evidenced by frequent enlargement of the DTAs following revascularization surgeries in adult patients, highlighting their adaptive response to chronic hypoperfusion.^[24] Traumatic injuries to the temporal region can lead to the formation of pseudoaneurysms or arteriovenous fistulas involving the DTAs, particularly in cases of iatrogenic trauma such as fronto-temporal craniotomy, where disruption of the arterial wall results in a contained hematoma that communicates with the vessel lumen and risks rupture with significant hemorrhage.^[25] These complications can manifest weeks post-injury, such as with repeated subcutaneous hemorrhage, underscoring the DTA's vulnerability in penetrating or blunt head trauma despite its deeper location compared to the superficial temporal artery. In chronic subdural hematoma, the DTAs can serve as a concealed feeding vessel, contributing to hematoma recurrence following middle meningeal artery embolization by supplying persistent arterial input to the subdural space through dural anastomoses.^[26] This role was demonstrated in a reported case where DTA embolization resolved recurrent hematoma after initial treatment failure, emphasizing the need to consider accessory extracranial feeders in refractory cases.^[27] Giant cell arteritis (GCA), a systemic vasculitis affecting medium- and large-sized arteries, rarely involves the DTAs compared to the superficial temporal artery, but inflammation can occur, leading to mural thickening and enhancement detectable on high-resolution MRI.^[28] Clinical manifestations include headache and jaw claudication due to ischemia in the temporalis muscle supplied by the affected DTAs, with MRI showing moderate correlation between imaging findings and symptoms, thus aiding noninvasive diagnosis when superficial vessel involvement is minimal.^[29] Additionally, the DTAs may contribute to the vascular supply of arteriovenous malformations (AVMs) or dural arteriovenous fistulas (DAVFs) in the temporal region via their anastomotic networks with dural and pial vessels, potentially exacerbating shunting and venous hypertension in these pathologic conditions.^[16]

Comparative anatomy

In mammals

The deep temporal arteries are a conserved feature in most mammalian species, consistently arising as branches of the maxillary artery to provide essential blood supply to the temporalis muscle, which facilitates mastication by elevating and retracting the mandible.^[30] This vascular arrangement supports the muscle's role in the complex mechanics of jaw movement across diverse mammalian lineages, from small rodents to large herbivores.^[31] These arteries generally originate from the proximal portions of the maxillary artery and follow a course through the temporal fossa, penetrating the temporalis muscle to distribute blood to its superficial and deep layers.^[32] In many species, including primates and carnivores, the deep temporal arteries divide into anterior and posterior branches, allowing targeted perfusion to the anterior and posterior aspects of the temporalis for efficient contractile function during biting and chewing.^[33] Similar to their configuration in humans, where the anterior and posterior branches emerge from the second part of the maxillary artery, this bifurcated pattern enhances vascular redundancy in these groups.^[1] In non-human primates, such as macaques and chimpanzees, the deep temporal arteries follow a similar course to humans, branching from the maxillary artery to supply the temporalis muscle, with variations in branching patterns observed across species that reflect differences in masticatory demands.^[34]

In veterinary contexts

In dogs, the deep temporal arteries arise as branches of the maxillary artery and are structurally similar to those in humans, primarily supplying blood to the temporalis muscle.^[35] These vessels are crucial for vascular support during surgical applications, such as temporalis muscle flaps used in oral and maxillofacial reconstructions to repair oronasal fistulas or maxillary defects, providing reliable pedicled tissue with minimal donor site morbidity.^[36]^[37] Canine anatomy studies, including detailed dissections, consistently highlight the consistent yet variable origins of these vessels, underscoring their reliability in surgical planning.^[38] In horses, the rostral and caudal deep temporal arteries branch from the maxillary artery to supply the expansive temporalis muscle, which is flat and wide to accommodate powerful lateral jaw movements during mastication.^[39]^[30] Similarly, in cattle, these arteries are documented as key branches of the maxillary system, with enlarged dimensions reflecting the robust masticatory demands of ruminant herbivores processing tough forage.^[40]

References

[1]
Anatomy, Head and Neck: Internal Maxillary Arteries - NCBI - NIH
Jun 5, 2023 · The maxillary artery supplies deep structures of the face including the mandible, pterygoid, infratemporal fossa and segments of the pterygopalatine fossa.
[2]
Deep temporal arteries | Radiology Reference Article
Feb 12, 2019 · The deep temporal arteries (anterior, middle and posterior) are branches from the second part of the maxillary artery. They ascend between the temporalis ...
[3]
Temporal fossa: anatomy, borders and contents - Kenhub
The deep temporal arteries (anterior, middle and posterior) are branches from the second part of the maxillary artery. They course superiorly between the ...
[4]
The Deep Temporal Arteries: Anatomical Study with Application to ...
Sep 22, 2022 · DTAs are branches of the second part of the maxillary artery, which pass through the supraperiosteal layer of the temporal fossa. DTAs may also ...
[5]
https://radiopaedia.org/articles/deep-temporal-arteries
[6]
Deep Temporal Arteries (Left) | Complete Anatomy - Elsevier
The deep temporal arteries, anterior and posterior, arise from the maxillary artery, ascend above the zygomatic arch, and supply the temporalis muscle.
[7]
Orbital anastomoses of the anterior deep temporal artery
The anterior deep temporal artery may provide a major collateral pathway to the intracranial circulation through anastomoses with branches of the ophthalmi.
[8]
Arterial branches to the temporal muscle - PubMed
The branches of the maxillary artery could be separate (anterior deep temporal, posterior deep temporal and accessory deep temporal arteries) or together with ...
[9]
The temporalis: blood supply and innervation - PubMed
In this study, 60 human cadavers were investigated to identify the arteries and nerves supplying the temporalis.
[10]
Clinical Anatomy of the Maxillary Artery - J-Stage
The inferior alveolar artery and the anterior deep temporal artery showed the smallest variations when the site of the origin of each branch of the ...<|separator|>
[11]
Implications for Improving the Safety of Deep Temporal Injections
The anatomical level of the DTA is located between the temporal muscle and the periosteal layer. Compared with observations in previous studies, the anterior ...Missing: prevalence | Show results with:prevalence
[12]
Anatomical Mapping of Temporalis Muscle Arterial Origins Relative ...
Jun 25, 2025 · The origin of the deep temporal arteries, the MA, divides into three segments along its nearly horizontal course [10]. These are the mandibular ...
[13]
The blood supply of the human temporalis muscle: a vascular ... - NIH
The temporalis muscle was found to be consistently supplied by 3 arteries: the anterior and posterior deep temporal arteries, and the middle temporal artery.
[14]
Anatomy, Head and Neck, Mastication Muscles - StatPearls - NCBI
Blood Supply and Lymphatics The arterial supply to the muscles of mastication is via the maxillary artery, a branch of the external carotid artery.Missing: flow | Show results with:flow
[15]
Dangerous Extracranial–Intracranial Anastomoses and Supply to ...
Three regions along the skull base constitute potential anastomotic routes between the extracranial and intracranial arteries.
[16]
Intracranial Collateral Pathways - neuroangio.org
Statistically, the most frequently recruited collateral routes are through the anterior deep temporal artery and middle meningeal artery, with less ...
[17]
https://doi.org/10.1007/s42399-025-02139-0
[18]
Anatomy of the Ophthalmic Artery: Embryological Consideration - PMC
The anterior deep temporal artery may anastomose to the lacrimal artery. The septal branch of the sphenopalatine artery may anastomose to the anterior and ...
[19]
https://onlinelibrary.wiley.com/doi/10.1002/ca.23952
[20]
Temporalis Muscle Flap in Head and Neck Reconstructions Is ... - NIH
The muscle has a reliable vascularity, and is classified under Mathes—Nahai type III, with two dominant vascular pedicles—the deep and superficial temporal ...
[21]
Complications after cosmetic periocular filler: prevention and ...
Aug 15, 2020 · The zygomatico-temporal artery connects the anterior deep temporal artery ... Verification of embolic channel causing blindness following filler ...
[22]
A structured approach with Swiss cheese model to reduce vascular ...
Oct 20, 2023 · Deep temporal artery anatomy: implications for improving the safety of deep temporal injections. Aesthetic Plast Surg. 2023. doi:10.1007 ...
[23]
Technical approaches for preservation of the temporalis muscle in ...
The vascular anatomy of the human temporalis muscle: implications for surgical splitting techniques. Int J Oral Maxillofac Surg 1996;25:414–21. [DOI] ...
[24]
Cerebrovascular Reserve Impairment in the Anterior Cerebral Artery ...
The DTA frequently enlarges after combined revascularization surgery, even in adult patients with moyamoya disease.
[25]
Iatrogenic Pseudoaneurysm at the Deep Temporal Artery after ... - NIH
Pseudoaneurysm at the DTA is a rare but possible complication after fronto-temporal craniotomy, which can be fatal due to marked hemorrhage.<|separator|>
[26]
A Novel Case of Deep Temporal Artery (DTA) Embolization for ... - NIH
Apr 26, 2023 · We report the first case of recurrent subdural hematoma post MMA embolization that was successfully treated with embolization of DTA.Missing: vessel | Show results with:vessel
[27]
A Novel Case of Deep Temporal Artery (DTA) Embolization for ...
Apr 26, 2023 · We report the first case of recurrent subdural hematoma post MMA embolization that was successfully treated with embolization of DTA.Missing: feeding vessel
[28]
MRI displays involvement of the temporalis muscle and the deep ...
Jun 4, 2014 · MRI visualizes changes in the temporalis muscle and the deep temporal artery in GCA. Moderate correlation of clinical symptoms with MRI results was observed.
[29]
MRI displays involvement of the temporalis muscle and the deep ...
Jun 4, 2014 · Involvement of the superficial temporal artery can be absent or weak in patients with giant cell arteritis, even though it is a common symptom. ...<|separator|>
[30]
Temporalis muscle - vet-Anatomy - IMAIOS
Vessels and nerves: Blood is supplied by the deep temporal arteries and collaterals of the maxillary artery. ... Comparative anatomy in humans. Temporalis ...
[31]
Jaw shape and mechanical advantage are indicative of diet ... - Nature
Feb 23, 2021 · A study on cranial morphology of rodents found a similar pattern: herbivores have enlarged masseter and temporalis muscles, while carnivores ...
[32]
[PDF] PDF 2.42 M - Assiut Veterinary Medical Journal
The caudal deep temporal artery (1/9) is the largest one among those of the first part of the maxillary artery. It arises from its dorsal aspect before it ...
[33]
Innervation Patterns of the Canine Masticatory Muscles in ...
Dec 28, 2009 · Dvorak (1976) performed the comparative study on the weight of the masticatory muscles, using apes, carnivores, herbivores, rodents, and human, ...
[34]
Species-specific modifications of mandible shape reveal ... - NIH
Nov 14, 2015 · When compared with omnivore and carnivores, herbivore species have smaller temporalis muscle. This results in a comparatively reduced ...
[35]
The blood supply to the canine middle ear
Apr 15, 2016 · The goal of this study was to identify and describe branches of the external carotid and maxillary arteries in close proximity to the TMJ that supply the ...<|control11|><|separator|>
[36]
Oronasal fistula repair utilizing a temporalis muscle flap in a dog ...
A temporalis myofascial rotation flap allowed for successful resolution of the maxillary defect. Implementation of the flap was relatively simple and was ...
[37]
Use of the Temporalis Muscle Flap in the Dog - TOMLINSON - 1981
A temporalis muscle graft provides a simple and effective means of closing orbitonasal defects. The principles and operative approach for the use of the ...
[38]
Caudal deep temporal artery - vet-Anatomy - IMAIOS
Caudal deep temporal artery - Horse - Teeth - Vasculature of teeth - vet-Anatomy.
[39]
Head – CVM Large Animal Anatomy
The temporal bones have 3 parts: squamous (flat), petrous (contains middle and inner ear), and the mastoid processes (neck muscle insertion). Figure 14B-6 ...
[40]
Use of Percutaneous Arterial Embolization for Treatment ... - PubMed
Results indicate the feasibility of embolization of the terminal branches of the maxillary artery to control epistaxis in dogs that do not require surgery.
[41]
Collateral Circulation - an overview | ScienceDirect Topics
Collateral vessels can potentially provide the tissue with blood flow while the artery normally supplying the blood is occluded. Therefore, collateral ...
[42]
Carnivore Anatomy Lab 25 Introduction
- internal carotid artery (dog) & carotid sinus (located on the occipital a. ... caudal deep temporal a. middle meningeal a. external ophthalmic a. palatine ...