Traumatic superior orbital fissure syndrome

McAvoy, C E; Lacey, Brendan; Page, A B

doi:10.1038/sj.eye.6701320

Cited by 13 publications

(7 citation statements)

References 4 publications

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“…Traumatic aneurysm of the internal carotid artery, carotid-cavernous sinus fistula, and transmitted force causing a temporary neuropraxia are other indirect causes. 3,6 Anatomically, the clinical signs of SOFS can be explained by the involvement of the respective nerve. External ophthalmoplegia and ptosis occur due to impairment of the III, IV, and VI nerves.…”

Section: Discussionmentioning

confidence: 99%

Successful Conservative Management of a Case of Traumatic Superior Orbital Fissure Syndrome

Shanker¹,

Nigam²,

Misra³

2016

IJNT

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We report the case of a 22-year-old man who presented with complete ptosis, anisocoria, and total limitation of ocular motility of the right eye following blunt trauma. He was diagnosed to have traumatic superior orbital fissure syndrome based on clinical and radiologic evaluation. The patient achieved complete recovery of cranial nerve function. This unusual complication is reported in less than 1% of cases of craniomaxillofacial trauma. The clinical presentation with external and internal ophthalmoplegia but sparing of vision occurs as a result of the functional compromise of the neurovascular structures traversing the superior orbital fissure while sparing the optic nerve within the optic canal. Management may include observation, repair of associated fractures, megadose steroid therapy, and surgical decompression of the superior orbital fissure. A review of literature reveals that this condition with a unique ocular presentation is underreported in ophthalmic literature, perhaps as initial diagnosis may be obscured by coexisting craniofacial trauma.

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Section: Discussionmentioning

confidence: 99%

Successful Conservative Management of a Case of Traumatic Superior Orbital Fissure Syndrome

Shanker¹,

Nigam²,

Misra³

2016

IJNT

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“…In this sense SOFS reflects neurovascular structures injuries crossing the superior orbital fissure causing ptosis and ophthalmoplegia (cranial nerves III, IV, VI), proptosis (superior ophthalmic vein), and anesthesia of the upper eyelid and forehead (cranial nerve V1) and occurs in complete or partial form fit to the etiology trauma, infection, tumors or haemorrhages 4,6,7 . This fact corroborates the case already presented that the patient was the victim of car accident by trampling resulting in multiple fractures of face associated with SOFS which increases the complexity of the case difficult treatment plan by a professional with little experience.…”

Section: Discussionmentioning

confidence: 99%

“…Common causes include cancer, inflammation or trauma often associated with craniofacial fractures simultaneous 4 . Thus, the purpose of this report is to present the case of a patient, hit and run victim with multiple facial fractures resulting in Superior Orbital Fissure Syndrome.…”

Section: Introductionmentioning

confidence: 99%

Superior orbital fissure syndrome after facial trauma

Jardim¹,

Faverani²,

Masocatto³

et al. 2017

Arch Health Invest

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The superior orbital fissure is a crack that communicates with the middle cranial fossa and is located between the greater and lesser wings of the sphenoid in the posterior region of the orbit. It presents a close relationship with several important structures such as the optic foramen and II, III, IV, V and VI cranial nerve and the sphenoid and ethmoid sinuses. Zygomatic-orbital fracture may trauma in the posterior region of the orbit and may result in the Superior Orbital Fissure Syndrome (SOFS) or Apex Orbital Syndrome (AOS). The superior orbital fissure syndrome results from compression structures that pass this region, resulting in paralysis of the cranial nerves III, IV and VI. Clinically, the patient has ptosis, mydriasis and ophthalmoplegia, it is very important that the diagnosis is made before the surgical manipulation of reduction and fixation of zygomatic fracture. Case report: A male patient, 37, hit and run victim was survived by Trauma Surgery Team. Diagnosed with head trauma and diffuse axonal injury, it was transferred to the Intensive Care Unit (ICU) where he stayed for three weeks. It was conducted by the Oral and Maxillofacial Surgery and was diagnosed zygomaticomaxillary fracture type Le Fort III and mandibular fracture associated with SOFS. The surgical treatment of mandibular and zygomaticomaxillary fractures was conducted. The ptosis devolved and postoperative 6 months was noted complete remission of the syndrome signals. Descriptors: Craving; Optical Nerve; Syndrome; Cranial Nerve. ResumoA fissura orbitária superior é uma fenda que se comunica com a fossa craniana média e localiza-se entre as asas maior e menor do esfenoide na região posterior da órbita. Apresenta íntima relação com diversas estruturas nobres, como o forame óptico e os II, III, IV, V e VI pares cranianos e os seios esfenoidal e etmoidal. Fratura zigomático-orbitária pode desencadear trauma na região posterior da órbita, podendo resultar na Síndrome da Fissura Orbitária Superior (SFOS) ou na Síndrome do Ápice Orbitário (SAO). A síndrome da fissura orbitária superior é resultante da compressão de estruturas que passam nessa região, resultando na paralisia dos pares cranianos III, IV e VI. Clinicamente o paciente apresenta ptose palpebral, midríase e oftalmoplegia, sendo muito importante que o diagnóstico seja feito anteriormente a manipulação cirúrgica de redução e fixação da fratura de zigoma. Relato de caso: Paciente do gênero masculino, 37 anos, vítima de atropelamento, foi socorrido por Equipe de Cirurgia do Trauma. Com diagnóstico de traumatismo craniano e lesão axonal difusa, o mesmo foi transferido para Unidade de Terapia Intensiva (UTI) aonde permaneceu por 3 semanas. Foi reavaliado pela Cirurgia e Traumatologia Bucomaxilofacial e diagnosticou-se fratura zigomático-maxilar do Tipo Le fort III e fratura mandibular associado a SFOS. Realizou-se tratamento cirúrgico das fraturas mandibular e zigomático-maxilares. A ptose palpebral involuiu e no pós-operatório de 6 meses notou-se completa remissão dos sinais da...

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“…Bony fragments can disrupt the structures in this region directly, as in this case with displaced bone fracture fragment or by secondary effects resulting from causes such as edema, increased intraocular pressure, or hematoma. 2,10,11 Traumatic SOFS can present clinically with internal and/or external ophthalmoplegia, hypoesthesia or anesthesia in the frontal periorbital region, corneal anesthesia, proptosis, ptosis, and lacrimal hyposecretion. 2,11 The presence of exophthalmos should raise suspicion for traumatic carotid-cavernous fistula, in which case a CT angiogram and/or formal four-vessel angiogram should be performed.…”

Section: Discussionmentioning

confidence: 99%

Neuronavigation-Guided Endoscopic Decompression of Superior Orbital Fissure Fracture: Case Report and Literature Review

Gasco¹,

Hooten²,

Ridley³

et al. 2009

Skull Base

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Objective: We present a rare case of an isolated superior orbital fissure fracture resulting from blunt injury to the face and presenting with selective cranial nerve deficits surgically treated with a neuroendoscopic approach. The anatomy of the superior orbital fissure is detailed, and the peculiarities of the surgical approach described. Method: A review of the existing literature reveals this is the first reported case of a neuronavigation-assisted endoscopic approach used in the extraction of a superior orbital fracture fragment with good outcome. Current guidelines for an endoscopic approach in orbital trauma are reviewed, and pertinent literature is discussed. Conclusion: Neuronavigation-assisted decompression should be considered as an effective means of removing superior orbital fissure fractures.

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Traumatic superior orbital fissure syndrome

Cited by 13 publications

References 4 publications

Successful Conservative Management of a Case of Traumatic Superior Orbital Fissure Syndrome

Successful Conservative Management of a Case of Traumatic Superior Orbital Fissure Syndrome

Superior orbital fissure syndrome after facial trauma

Neuronavigation-Guided Endoscopic Decompression of Superior Orbital Fissure Fracture: Case Report and Literature Review

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