Where is the supraorbital notch located?
The supraorbital notch is located on the external surface of the cranium (facies externa). It is part of the supraorbital margin (margo supraorbitalis), which serves as the inferior boundary of the external surface and forms the superior limit of the orbital opening (aditus orbitalis).
The notch is localized in the medial half of the supraorbital margin. Variations in structure are possible: the margin may feature a supraorbital notch (incisura supraorbitalis) or a supraorbital foramen (foramen supraorbitale). Medial to it, closer to the glabella (glabella), a frontal notch or foramen (incisura/foramen frontale) may be present.
What structures pass through the supraorbital notch?
The supraorbital margin connects the orbit with the facial region. The following neurovascular structures are associated with the supraorbital notch:
- Frontal nerve (n. frontalis) is a branch of the ophthalmic nerve (n. ophthalmicus), which is the first branch of the trigeminal nerve.
- Supraorbital artery (a. supraorbitalis) is a branch of the ophthalmic artery (a. ophthalmica). It emerges onto the forehead through the incisura supraorbitalis, supplies the frontal belly of the m. occipitofrontalis and the skin of the forehead, and anastomoses with the a. temporalis superficialis.
- Supraorbital vein (v. supraorbitalis).
Sensory pathway
The fibers passing through the supraorbital notch are peripheral processes of primary neurons — pseudounipolar cells of the trigeminal (Gasserian) ganglion (ganglion trigeminale). They contact receptors that perceive pain, temperature, pressure, and touch.
The central processes of these cells enter the tegmentum of the pons and terminate in the sensory nuclei:
- Nucleus tractus spinalis n. trigemini — processes pain and temperature.
- Nucleus sensorius superior n. trigemini — processes tactile sensation.
The axons of the secondary neurons decussate and terminate in the ventral nuclei of the thalamus, while tertiary neurons originate in the thalamus and transmit impulses to the lower parts of the postcentral gyrus.
Clinical significance
- Assessment of motor response: when pressure is applied to the supraorbital notch, a patient who localizes pain by raising their hand above the clavicle receives a score of 5.
- Blood flow assessment: the ophthalmic artery is clinically important for evaluating collateral circulation between the internal and external carotid artery systems.
Class and exam questions
How does the supraorbital notch differ from the supraorbital foramen?
These are anatomical variations of the supraorbital margin: in one case, there is a supraorbital notch (incisura supraorbitalis), and in another, a supraorbital foramen (foramen supraorbitale).
Which nerves emerge onto the face through this notch?
It transmits the frontal nerve (n. frontalis) to the face, which is a branch of the ophthalmic nerve (n. ophthalmicus), representing the first branch of the trigeminal nerve.
Why do doctors press on the supraorbital notch?
Pressure applied to this area is used as a painful stimulus to assess motor response. Localization of pain by the patient is scored as 5 points.
What else to study on this topic
- Ophthalmic nerve (n. ophthalmicus) and its branches
- Ophthalmic artery (a. ophthalmica)
- Structure of the orbit (Cavitas orbitalis)
- Trigeminal nerve (n. trigeminus) and its nuclei
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