).Superior orbital fissure syndrome (SOFS) is an interesting symptom complex, which poses difficult questions for the treating physicians. SOFS can arise from multiple etiologies and mechanisms. Presented in the following is a review of a recent traumatic incident confounded by SOFS.
Case PresentationA 44-year-old man, status-post fall down eight concrete steps, was transported to the Nassau University Medical Center Emergency Department by emergency medical services and presented with a Glasgow Coma Scale of 13. Advanced Trauma Life Support protocol was followed. Neurosurgery service was consulted for a subdural hematoma, the Oral and Maxillofacial Surgery service was consulted to evaluate and treat multiple facial fractures and lacerations, and the Ophthalmology service was consulted to assess any visual disturbances resulting from the periorbital injuries. The patient was admitted to our institution on the Trauma service. The patient denied any medical or surgical history. He also reported taking no medications and having no known drug allergies or sensitivities. His social history was pertinent for alcohol consumption, but the patient denied tobacco or illicit drug use.On initial head and neck physical examination, the patient displayed left periorbital edema and ecchymosis, left lid ptosis, limited mandibular range of motion, a palpable step at the left infraorbital rim, and decreased left facial projection (►Fig. 1). The ophthalmologic examination revealed no acute deficit in visual acuity, minimally elevated left intraocular pressure (left: 21 vs. right: 17) and anisocoria with the left pupil dilatated to 5 mm versus the right at 3 mm. Also noted was an intact afferent pupillary response, paresthesia of the left frontal region, full restriction of motion of the left globe in all fields of gaze, and forced duction test was negative for entrapment of the extraocular muscles (►Fig. 2). Further ophthalmologic evaluation demonstrated no evidence of optic nerve edema, neuropathy, or retinal detachment.Imaging included a maxillofacial computed tomography (CT) which revealed comminuted fractures of the anterior, posterolateral, and posteromedial walls of the left maxillary sinus with air fluid levels and a hematoma. In addition, fractures of the left orbital roof and lateral and inferior walls were noted. The globes were found to be intact, with no definitive evidence of muscle entrapment. However, disruption of the left superior orbital fissure was found (►Figs. 3 and 4).Subsequently, the diagnosis was made of a left zygomaticomaxillary complex (ZMC) fracture with associated SOFS caused by compression of the fissure by bony segments. After discussion of treatment options, an open reduction with Keywords ► trauma ► midface ► superior orbital fissure syndrome ► zygomaticomaxillary complex fracture
AbstractSuperior orbital fissure syndrome is an infrequently encountered entity with a unique presentation and significant morbidity. This article reviews the background of the syndrome, treatments in the literature, and...
