The anterior ethmoidal nerve is a branch of the nasociliary nerve (from V1) that passes through the anterior ethmoidal foramen in the medial orbital wall to enter the anterior cranial fossa, then descends through the cribriform plate to enter the nasal cavity, where it supplies the anterior nasal septum and lateral nasal wall. A small external nasal branch exits between the nasal bone and the upper lateral cartilage to supply the skin of the nasal tip and alae.
The anterior ethmoidal nerve provides the sensory supply to the anterior nasal cavity and the skin over the nasal tip. Local anaesthetic at the anterior ethmoidal foramen (accessible transnasally) blocks the anterior nasal cavity sensation for nasal procedures. The external nasal branch at the dorsal nasal tip is at risk during open rhinoplasty transcolumellar incisions, though sensory return usually occurs. The anterior ethmoidal artery accompanying this nerve is a common source of anterior epistaxis (Kiesselbach plexus in Little's area on the anterior septum).
The external nasal branch of the anterior ethmoidal nerve crossing between the nasal bone and upper lateral cartilage is at risk during open rhinoplasty and external nasal dissection, producing temporary or permanent numbness of the nasal tip skin that typically recovers within 6-12 months.
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