Supraorbital notch !

The supraorbital notch is a groove in the upper rim of the eye socket; the supraorbital nerve and vessels pass through it to the forehead.

Official name: Incisura supraorbitalis

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What it is

A notch in the upper rim of the eye socket.

What it does

The supraorbital nerve and vessels go to the forehead.

Key facts

Where: Frontal bone, inner third of the upper orbital margin (sometimes a foramen)
Function: Transmits the supraorbital nerve (V1) and vessels to the forehead

Relations

Contents: Supraorbital nerve, a branch of the frontal nerve (V1), with the supraorbital artery from the ophthalmic artery and its vein
Course: The frontal nerve runs forward on levator palpebrae superioris under the orbital roof and divides; its supraorbital branch leaves through the notch and climbs the forehead under frontalis, splitting into medial and lateral branches to the scalp
Medial: Supratrochlear nerve and vessels, leaving the orbit above the trochlea of the superior oblique
Superficial: Orbicularis oculi, corrugator supercilii and frontalis, with the skin of the eyebrow
Below: Orbital roof, with the frontal nerve and levator palpebrae superioris beneath; the frontal sinus often extends to just medial of the notch

How to find it

Felt by running a fingertip along the upper orbital rim from medial to lateral: a small groove or tender spot roughly above the pupil, with the eyes looking straight ahead. When it is a foramen it lies a little above the rim and is harder to feel.

Examination

Supraorbital pressure: firm pressure on the notch is a central pain stimulus used in coma scoring; a hand brought up toward it counts as localising. It is not used when a facial fracture is suspected

On imaging

CT of the face shows it on coronal images and 3D bone reconstructions as a notch, or a closed foramen, in the upper orbital rim in line with the pupil. It is mainly a landmark: in frontal bone and orbital rim fractures, CT shows whether the line runs through it, which explains numbness of the forehead. Ultrasound can find the notch to guide a supraorbital nerve block.

Clinical notes

Supraorbital nerve block at the notch, often with a supratrochlear block, numbs the forehead and front of the scalp for repair of lacerations
Blows to the brow and frontal sinus fractures can bruise the nerve: numbness or tingling of the forehead and scalp toward the vertex
In brow-lift and frontal sinus approaches the nerve is identified at the notch and preserved; a closed foramen may need to be opened to free it
Irritation of the nerve at the notch can cause pain in its territory (supraorbital neuralgia)

Anatomical variants

A notch, a closed foramen, or both on the same rim; texts differ on how often each occurs, and the two sides often differ

Test yourself

Think of the answer, then tap the question to see it.

Which nerve passes through the supraorbital notch, and what does it supply?

The supraorbital nerve (from the frontal nerve, V1): the forehead and the scalp back to about the vertex.

Which three trigeminal exits lie on the vertical line through the pupil?

The supraorbital notch (V1), the infraorbital foramen (V2) and the mental foramen (V3).

Why is a supratrochlear block often added to a supraorbital notch block?

The supratrochlear nerve leaves the orbit closer to the midline, so both are needed to numb the forehead and front of the scalp.

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Educational information, not medical advice. For any symptom, see a health professional.

Its names

Official Latin (TA2): incisura supraorbitalis TA2 528
Official Spanish (DeCS): Escotadura supraorbitaria
English (TA2): Incisura supraorbitalis
Also called: incisura frontalis lateralis

Sources: Terminologia Anatomica (TA2); Supraorbital Nerve Block; Anatomy, Head and Neck: Frontal Bone.

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