The Superficial Temporal Artery: Anatomical Variations in Course, Branching Patterns, Depth Relationships, and Anastomotic Networks—A Systematic Review of Cadaveric and Imaging Evidence

The superficial temporal artery (STA), a terminal branch of the external carotid artery, serves as the principal vascular axis of the temporoparietal region and lateral scalp, yet demonstrates clinically relevant variability in bifurcation level, terminal branching pattern, duplication, and fascial-plane relationships. A PRISMA-oriented systematic review of MEDLINE (PubMed), supplemented by citation chasing and limited Scopus discovery, included cadaveric dissections, CTA, DSA, and operative-anatomy studies reporting STA course, morphometry, depth relationships, and anastomoses. Most series reported bifurcation above the zygomatic arch (~74%-90% in cadaveric data; pooled ≈79%), although consistent sub-arch and at-arch variants were identified. Additional variants included absent bifurcation, duplicated frontal or parietal branches, trifurcation, and variable zygomatico-orbital artery anatomy. Morphometric findings showed population-dependent and modality-dependent diameters with reproducible surface landmarks relative to the tragus and zygomatic arch. Overall, while the STA trunk course is generally conserved, this study highlights substantial anatomical variation in terminal branching, depth relationships, and anastomotic patterns across populations and modalities. Importantly, this review is positioned as an anatomical synthesis that complements prior ultrastructural scalp/pericranial work by focusing specifically on STA course, branching variation, fascial-plane relationships, and clinically relevant anastomoses. The main achievement of this review is the extraction of a unified, variation-focused anatomical framework from cadaveric, CTA, and DSA evidence, showing that the STA should be understood as a reliable trunk with variable bifurcation, variable terminal branch multiplicity, and clinically important plane-based relationships. Unlike prior reviews, this synthesis integrates cadaveric and in vivo imaging evidence to provide a unified framework of anatomical variation with direct surgical relevance. This comprehensive variation-focused perspective supports safer planning for scalp flaps, STA biopsy, and craniofacial procedures.