The superficial temporal artery arises from a branch of the external carotid artery and turns beneath the parotid gland. This artery then runs superficially, approximately 1 cm below the level of the ear tragus. Subsequently, it routinely gives off four branches: the zygomatic branch, a branch to the auricle, an anterior branch, and a posterior branch. There are many variations in the positions of these branches. The zygomatic artery becomes a branch of the anterior branch when the latter leaves the superficial temporal artery at a more proximal point. However, even the size of the auricular branch, which is usually located just over the small mimic muscle of the auricle, varies.

The main trunk of the superficial temporal artery usually makes a wide curve between the level of the ear tragus and 2 cm above it. After giving off its anterior branch, it then runs toward the top of the head, where it provides a posterior branch. Along the latter it gives off a branch posteriorly, that is usually not evident in the angiography of the external carotid artery, but is easier to see when it is dissected out clinically. This branch is located about the distance of two to three fingerbreadths from the hairline, just over the auricle. This small branch and the posterior branch of the superficial temporal artery may have multiple anastomoses between them and the posterior auricular artery and the occipital artery itself. The arterial supply of the free temporo-occipital flap is based on these two branches (Fig. 7.2).

Routinely, the vein runs posterior and superior to the superficial temporal artery, but it can often be seen wrapped around the artery, especially at the level of the tragus. Then it usually receives two tributaries that are accompanied by the anterior and posterior branches of the superficial temporal artery. A tributary from the auricle joins either the posterior part of the superficial temporal vein or its common trunk. There are venae comitantes accompanying the superficial temporal artery, but they are usually quite small in caliber. The main drainage of the free temporo-occipital flap appears to be the posterior tributary of the superficial temporal vein.