The lingual artery (from the ECA) divides into three main branches after passing deep to the hyoglossus: the dorsal lingual arteries (two or three small vessels to the tongue base and posterior dorsum, and the epiglottis — the subhyoid branch and the epiglottic branches), the sublingual artery (to the sublingual gland, mylohyoid, and anterior floor of mouth), and the deep lingual artery (the terminal branch running along the inferior tongue surface to the tip, the main tongue body supply).
Knowledge of lingual artery branch anatomy is critical in glossectomy surgery: partial glossectomy for anterior tongue carcinoma requires ligation of the deep lingual artery at the appropriate level to achieve haemostatic resection while preserving posterior tongue perfusion from the dorsal lingual branches. In tongue reconstruction with free flap, the native lingual artery stumps (after total glossectomy) provide the recipient vessels for microanastomosis. The sublingual artery is at risk during submandibular duct stone extraction from the floor of mouth.
Partial anterior tongue glossectomy requires ligation of the deep lingual artery running along the tongue floor to the tip, while preserving the dorsal lingual branches to the posterior tongue that maintain viability of the tongue base remaining after resection; the lingual artery is first ligated proximally at the hyoglossus level to control bleeding before the tongue is divided.
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