• ABDELNASSER IBRAHIM Department of Pathology, Universiti Kebangsaan Malaysia Medical Centre, Jalan Yaacob Latif, Bandar Tun Razak, 56000, Kuala Lumpur, Malaysia.
  • SOHAYLA M ATTALLA Department of Forensic Medicine and Clinical Toxicology, Faculty of Medicine, 60 Elgomhoria Street, Mansoura University, 35516, Mansoura, Egypt.
  • ASPALILAH ALIAS Department of Pathology, Universiti Kebangsaan Malaysia Medical Centre, Jalan Yaacob Latif, Bandar Tun Razak, 56000, Kuala Lumpur, Malaysia.
  • MOHAMED SWARHIB Department of Pathology, Universiti Kebangsaan Malaysia Medical Centre, Jalan Yaacob Latif, Bandar Tun Razak, 56000, Kuala Lumpur, Malaysia.
  • SITI NOORAIN ABU BAKAR Department of Pathology, Universiti Kebangsaan Malaysia Medical Centre, Jalan Yaacob Latif, Bandar Tun Razak, 56000, Kuala Lumpur, Malaysia.
  • SRIJIT DAS Department of Anatomy, Universiti Kebangsaan Malaysia Medical Centre, Jalan Yaakob Latif, Bandar Tun Razak, 56000 Kuala Lumpur, Malaysia.
  • FARIDAH MOHD NOR Department of Pathology, Universiti Kebangsaan Malaysia Medical Centre, Jalan Yaacob Latif, Bandar Tun Razak, 56000, Kuala Lumpur, Malaysia.


Objective: A clear knowledge of the location of supraorbital foramen (SOF) is vital for the surgeons, particularly in endoscopic surgery and regional block in crania. The aim of this study was to analyze SOF and notch in skulls of various ancestries.

Methods: The anatomical variations of SOF and notch were examined in 100 adults skulls (55 males and 45 females) of the Malay, Chinese, and Indian ancestries by traditional measurement made with the Osirix software. The parameters included distance between supraorbital structure and nasal midline, shape, and transverse diameter of the SOF.

Results: It was manifested that bilateral supraorbital notch (SON) was the most prevalent combination in both sexes and ancestries (61%), while combined SON and foramen (11%) were the least prevalent characteristic. The mean distances of supraorbital structure from nasal midline bilaterally in males were slightly greater than females. The horizontal diameter of SOF, notch and their distances from the nasal midline showed no difference between ancestries.

Conclusion: This study would serve as a guide for the surgeons when surgery is performed on the scalp. It can help in the precise determination of reference points for supraorbital nerve blockade for the Malaysians. In addition, the variations exhibited in supraorbital measurements inevitably revealed that sex and ancestry should be taken into consideration when choosing samples for anatomical classification of crania.

Keywords: Ancestry,, Supraorbital foramen,, Anatomy,, Crania,, Forensic.


1. Chrcanovic BR, Abreu MH, Custódio AL. A morphometric analysis of supraorbital and infraorbital foramina relative to surgical landmarks. Surg Radiol Anat 2011;33:329-35.
2. Abrahams P H, Craven JL, Lumley JS. Illustrated Clinical Anatomy. Boca Raton, FL: CRC Press; 2011.
3. Singh S, Bilodi AK, Suman P. Morphometric analysis on supra-orbital notches and foramina in south indian skull. Int J Cur Res Rev 2013;5:43-50.
4. Gray H, Standring S. Gray’s Anatomy: The Anatomical Basis of Clinical Practice. 41th ed. Boca Raton, FL: Elseiver; 2016.
5. Gupta T. Localization of important facial foramina encountered in maxillo-facial surgery. Clin Anat 2008;21:633-40.
6. Dach F, Éckeli ÁL, Ferreira Kdos S, Speciali JG. Nerve block for the treatment of headaches and cranial neuralgias - A practical approach. Headache 2015;55 Suppl 1:59-71.
7. Alodeani EA. Botulinum toxin type A: An effective, safe and minimally invasive treatment option of axillary and palmar hyperhidrosis. Int J Pharm Pharm Sci 2016;8:237-40.
8. Jena S, Jena M, Patro N, Mishra S, Panda M,Dash M. Patterns of prescription and ADR monitoring of drugs in the management of neuropathic pain in a tertiary care teaching hospital. Int J Pharm Pharm Sci 2014;6:246-51.
9. Evans RW, Pareja JA. Supraorbital neuralgia. Headache: J Head Face Pain 2009;492:278-81.
10. Saylam C, Ozer MA, Ozek C, Gurler T. Anatomical variations of the frontal and supraorbital transcranial passages. J Craniofac Surg 2003;14:10-2.
11. Cutright B, Quillopa N, Schubert W. An anthropometric analysis of the key foramina for maxillofacial surgery. J Oral Maxillofac Surg 2003;61:354-357.
12. Beer GM, Putz R, Mager K, Schumacher M, Keil W. Variations of the frontal exit of the supraorbital nerve: An anatomic study. Plast Reconstr Surg 1998;102:334-41.
13. Hanihara T, Ishida H. Frequency variations of discrete cranial traits in major human populations. IV. Vessel and nerve related variations. J Anat 2001;199:273-87.
14. Malet T, Braun M, Fyad JP, George JL. Anatomic study of the distal supraorbital nerve. Surg Radiol Anat 1997;19:377-84.
15. Kimura K. Foramina and notches on the supraorbital margin in some racial groups. Kaibogaku Zasshi 1977;52:203-9.
16. Michael JT, Viner MD, Brogdon BG, editors. Brogdon’s Forensic Radiology. Boca Raton: CRC Press; 2010. p. 116.
17. Garg RK, Lee KS, Kohn SC, Baskaya MK, Afifi AM. Can sonography distinguish a supraorbital notch from a foramen? J Ultrasound Med 2015;34:2089-91.
18. Wang X, Wu W, Zhang H, Lan Q. Endoscopic optic nerve decompression through supraorbital keyhole extradural approach: A Cadaveric study. Turk Neurosurg 2017;27:212-6.
19. Hui W, Wang H, Luo L, Ye Z, Li W, Chen C, et al. Clipping of anterior communicating artery aneurysms in the early post-rupture stage via transorbital keyhole approach-Chinese neurosurgical experience. Br J Neurosurg 2015;29:644-9.
20. El-Sheikh E, Nasr WF, Ibrahim AA. Anatomical variations of supraorbital notch and foramen: A study on human adult Egyptian skulls. Eur J Plast Surg 2014;37:135-40.
21. Rosenberg GJ. The subperiosteal endoscopic laser forehead (SELF) lift. Plast Reconstr Surg 1998;102:493-501.
22. Erdogmus S, Govsa F. Anatomy of the supraorbital region and the evaluation of it for the reconstruction of facial defects. J Craniofac Surg 2007;18:104-12.
23. Tomaszewska A, Tomczyk J, Kwiatkowska B. Characterisation of the supraorbital foramen and notch as an exit route for the supraorbital nerve in populations from different climatic conditions. Homo 2013;64:58 70.
24. Woo SW, Lee HJ, Nahm FS, Lee PB, Choi EJ. Anatomic characteristics of supraorbital foramina in korean using three-dimensional model. Korean J Pain 2013;26:130-4.
25. Turhan-Haktan?r N, Aycicek A, Haktan?r A, Demir Y. Variations of supraorbital foramina in living subjects evaluated with multidetector computed tomography. Head Neck 2008;30:1211-5.
26. Cheng AC, Yuen HK, Lucas PW, Lam DS, So KF. Characterization and localization of the supraorbital and frontal axis of the supraorbital nerve in Chinese: Anatomic study. Ophth Plast Reconstr Surg 2006;22:209 13.
27. Trivedi DJ, Shrimanker PS, Kariya VB, Pensi CA. A study of supraorbital notches and foramina in Gujarati human skulls. Nat J Integ Res Med 2010;1:1-6.
28. Apinhasmit W, Chompoopong S, Methathrathip D, Sansuk R, Phetphunphipat W. Supraorbital notch/foramen, infraorbital foramen and mental foramen in Thais: Anthropometric measurements and surgical relevance. J Med Assoc Thai 2006;89:675-82.
29. Chung MS, Kim HJ, Kang HS, Chung IH. Locational relationship of the supraorbital notch or foramen and infraorbital and mental foramina in Koreans. Acta Anat (Basel) 1995;154:162-6.
30. Cugati NS, Kumar S. Localization and morphometric evaluation of supraorbital and infraorbital foramen in Dravidian Population of Southern India: A paleoantropological study on dry skulls. IOSR J Dent Med Sci 2013;5:18-23.
31. Webster RC, Gaunt JM, Hamdan US, Fuleihan NS, Giandello PR, Smith RC, et al. Supraorbital and supratrochlear notches and foramina: Anatomical variations and surgical relevance. Laryngoscope 1986;96:311-5.
32. Cisneiros de Oliveira LC, Silveira MP, de Almeida Júnior E, Reis FP, Aragão JA. Morphometric study on the infraorbital foramen in relation to sex and side of the cranium in Northeastern Brazil. Anat Cell Biol 2016;49:73-7.
209 Views | 86 Downloads
How to Cite