The authors report a case of total persistence of the hyoïdo-stapedial artery (HSA) discovered fortuitously in an adult. The external carotid artery terminated as the superficial temporal, middle deep temporal and transverse facial arteries; the HSA arose from the intrapetrous internal carotid artery, coursed within the middle ear and the middle cranial fossa where it gave off the middle meningeal artery before leaving the skull via the foramen spinosum to become the maxillary artery.