anterior lacrimal crest anterior lacrimal crest the anterior lacrimal crest is a bony projection on the frontal process of the maxilla. it creates the lateral margin of the lacrimal sac fossa and is continuous with the orbital margin. the medial palpebral ligament is attached to anterior lacrimal crest. it is an important structure to avoid damaging during rhinoplasty. anterior lacrimal crestdetailspart ofmaxillasystemskeletalidentifierslatincrista lacrimalis anteriorta98a02.1.12.025ta2782fma75059anatomical terms of bone structure the anterior lacrimal crest is a bony projection on the frontal process of the maxilla in the skull. it reaches the junction between the maxilla and the lacrimal bone. at its junction with the orbital surface is a small tubercle, the lacrimal tubercle, which serves as a guide to the position of the lacrimal sac. the anterior lacrimal crest is much thicker and stronger than the posterior lacrimal crest. it is one of the thickest parts of the orbit. it is nearly always quite prominent, whilst the posterior lacrimal crest may be less prominent in some people. relations the lacrimal sac is directly behind the anterior lacrimal crest, which protects it as part of the fossa for the lacrimal sac. function the anterior lacrimal crest is the site of insertion of the medial palpebral ligament. some consider this a tendon of the orbicularis oris muscle. the anterior lacrimal crest also protects the lacrimal sac. clinical significance avulsion the anterior lacrimal crest may be vulnerable to an avulsion fracture due to its connection to the medial palpebral ligament. rhinoplasty the anterior lacrimal crest is vulnerable to damage during osteotomy performed during rhinoplasty, a common plastic surgery. it lies approximately 5 mm from the osteotomy incision line.