The ascending pharyngeal artery (Fig. 4.1) has a complex course as it supplies many different areas of the head and neck including the posterior fossa of the skull base, the viscerocranium, the pharynx, the middle ear, and also the cervical spine. Furthermore, it forms several clinically significant anastomoses distally with other vascular territories. Because of rather than despite its complicated nature, the ascending pharyngeal artery can be a rewarding subject of study for the reader seeking a comprehensive understanding of head and neck anatomy.