Anatomical variability of the lingual artery: a comprehensive narrative review with clinical and surgical applications

The lingual artery (LA) provides primary blood supply to the tongue and floor of the mouth. Precise anatomical knowledge is essential for head and neck surgery and neurointervention to prevent haemorrhage, lingual necrosis, or non-target embolisation. This comprehensive narrative review synthesises current evidence on LA anatomy, variations, and clinical significance whilst critically appraising methodological limitations across the literature. A literature search of PubMed/MEDLINE, Scopus, Web of Science, and Google Scholar was conducted from database inception to 15 May 2025. Studies addressing LA anatomy, morphometry, variants, and clinical applications were qualitatively assessed for methodological quality. The LA typically originates from the external carotid artery at the greater horn of the hyoid bone and courses deep to the hyoglossus muscle. Common arterial trunks represent the most prevalent variants: linguofacial trunk (16–25%), thyrolingual trunk (0.3–3.3%), and thyrolinguofacial trunk (~ 1%). The hypoglossal nerve serves as a reliable surgical landmark, with the LA located inferior to or contacting the nerve in approximately 85% of cases. Dynamic topographic studies demonstrate that tongue extension and surgical retraction significantly alter vessel position, narrowing the midline safety corridor. CTA data suggest tongue extension reduces LA depth beneath the lingual surface by approximately 4 mm (27.9 ± 3.2 mm to 24.0 ± 2.7 mm at foramen cecum level) and decreases bilateral LA distance by approximately 6 mm (20.1 ± 3.1 mm to 13.9 ± 3.2 mm). Critical analysis revealed substantial inconsistencies in prevalence rates for cervical triangles, internal numerical discrepancies in foundational studies, absence of systematic bilateral assessment, and potential non-independence across sequential publications. Mastery of LA anatomy is indispensable for safe surgical practice. However, clinicians should interpret prevalence data cautiously given methodological limitations, small sample sizes, and potential sample overlap. Future studies with rigorous bilateral assessment and diverse populations are warranted.