Mapping the lingual artery: a scoping review and proposed imaging-informed risk classification for surgical and radiological practice
Abstract
Background: The lingual artery (LA) shows significant morphological and topographical variation that can affect the safety and results of head and neck surgeries, carotid interventions, and free flap reconstructions. Traditional descriptions such as the thyrolingual trunk (TLT), linguofacial trunk (LFT), and thyrolinguofacial trunk (TLFT) do not consider surgical risk assessment or the importance of modern imaging.
Objective: To comprehensively review LA origin and course variants, determine their prevalence in cadaveric and imaging datasets, and propose an imaging-informed, anatomy-based risk classification for surgical and radiological use.
Methods: A PRISMA Extension for Scoping Reviews (PRISMA-ScR)-aligned scoping review of PubMed, Scopus, and Web of Science (January 2007-May 2025) identified studies reporting LA variants through cadaveric dissection, computed tomography angiography (CTA), magnetic resonance angiography (MRA), or digital subtraction angiography. Only original studies in English containing primary variant data were included. Prevalence ranges were extracted, and a proposed anatomy-based classification (Classes I-III) was constructed according to branching pattern, shared trunk involvement, proximity to the carotid bifurcation or common carotid artery, and anticipated implications for vascular control. Because standardized clinical outcome data were inconsistently reported across the included studies, the framework should not be interpreted as…
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