Bilateral aberrant buccal arteries, hypoplastic facial arteries, and a fenestrated maxillary artery

Bilateral hypoplastic facial arteries terminating as submental arteries were identified on computed tomography angiography, accompanied by rare compensatory vascular patterns. The right maxillary artery exhibited a triangular fenestration between the maxillary tuberosity and inferior orbital fissure, from which an aberrant buccal artery arose and descended to supply the inferior lip. The left side demonstrated a common buccoalveolar trunk bifurcating into the inferior alveolar artery and an aberrant buccal artery with a previously unreported transmandibular trajectory, entering at the lingula and exiting through a retromolar foramen before continuing tortuously to vascularize the cheek and lower lip. These anatomical variants present significant surgical hazards during regional anesthesia procedures targeting the maxillary tuberosity, pterygomandibular space, and mandibular lingula, as well as during facial reconstructive surgery. Comprehensive preoperative angiographic evaluation is essential when facial artery hypoplasia is encountered to identify compensatory networks and prevent inadvertent vascular injury.