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# 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 points

- Lies on the vertical line through the pupil, with the infraorbital and mental foramina below it: three exits of the [trigeminal nerve](https://durgical.com/en/anatomy/trigeminal-nerve/) on one line
- The supraorbital nerve (from the frontal nerve, V1) supplies the forehead and the scalp back to about the vertex; injury here numbs that whole strip
- The supratrochlear nerve leaves the orbit closer to the midline, so blocks and forehead surgery deal with both nerves

## Key facts

**Where**
[Frontal bone](https://durgical.com/en/anatomy/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](https://durgical.com/en/anatomy/ophthalmic-artery/) and its vein

**Course**
The frontal nerve runs forward on [levator palpebrae superioris](https://durgical.com/en/anatomy/levator-palpebrae-superioris/) under the orbital roof and divides; its supraorbital branch leaves through the notch and climbs the forehead under [frontalis](https://durgical.com/en/anatomy/occipitofrontalis-muscle/), splitting into medial and lateral branches to the scalp

**Medial**
Supratrochlear nerve and vessels, leaving the orbit above the trochlea of the [superior oblique](https://durgical.com/en/anatomy/superior-oblique-muscle/)

**Superficial**
[Orbicularis oculi](https://durgical.com/en/anatomy/orbital-part-of-orbicularis-oculi/), [corrugator supercilii](https://durgical.com/en/anatomy/corrugator-supercilii/) and frontalis, with the [skin](https://durgical.com/en/anatomy/skin/) of the eyebrow

**Below**
Orbital roof, with the frontal nerve and levator palpebrae superioris beneath; the [frontal sinus](https://durgical.com/en/anatomy/sinus-of-frontal-bone/) 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](https://www.ncbi.nlm.nih.gov/books/NBK536937/); [Anatomy, Head and Neck: Frontal Bone](https://www.ncbi.nlm.nih.gov/books/NBK535424/).

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Representative model, for educational purposes only.

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Source: https://durgical.com/en/anatomy/incisura-supraorbitalis/
License: CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). Cite as: DurgiPedia (durgical.com), https://durgical.com/en/anatomy/incisura-supraorbitalis/