Traumatic Superior Orbital Fissure Syndrome: Current Management

Abstract

Traumatic superior orbital fissure syndrome is an uncommon complication of craniomaxillofacial trauma with an incidence of less than 1%. The syndrome is characterized by ophthalmoplegia, ptosis, proptosis of eye, dilation and fixation of the pupil, and anesthesia of the upper eyelid and forehead. This article describes a detailed anatomy of the superior orbital fissure as it related to pathophysiology and clinical findings. Etiology and diagnosis are established after detailed physical and radiographic examination. On the basis of our clinical experience in the management of superior orbital fissure syndrome and from the data reported previously in the literature, an algorithm for treatment of traumatic superior orbital fissure syndrome including use of steroid, surgical decompression of superior orbital fissure, and reduction of concomitant facial fracture is presented and its rationale discussed.

Injury to the Temporal Lobe via Medial Transorbital Entry of a Toothbrush

“…The patient's presentation was consistent with a traumatic SOF syndrome (RochonDuvigneaud syndrome), prompting urgent decompression of the SOF by removal of the foreign body. 21 The orbitofrontal modification of the frontotemporal orbitozygomatic approach used in this case allowed for decompression of the orbit and an improved trajectory, and also allowed the brain to sag away from the temporal skull base, thus minimizing the need for brain retraction while drilling the skull base. The majority of reported transcranial foreign bodies that traverse the SOF are introduced in a stabbing fashion, presumably at relatively low velocities.…”

Unilateral Mydriasis After Maxillary Osteotomy: A Case Series and Review of the Literature

“…Cavernous sinus lesions also affect the second division of cranial nerve V, a distinction that is difficult to make after maxillary osteotomy given the anticipated hypesthesia in this area. 31,32 The relatively rare association between SOF syndrome and craniofacial trauma, including zygomatic, orbital, and Le Fort fractures, is well documented; it occurs in less than 1% of craniofacial traumas. SOF syndrome after trauma can result from direct damage by displaced bone fragments or from indirect compression of the fissure's contents by hematoma, vascular impingement, or edema.…”

“…SOF syndrome after trauma can result from direct damage by displaced bone fragments or from indirect compression of the fissure's contents by hematoma, vascular impingement, or edema. 31 It also can result from mass lesions or inflammation. Cranial nerve recovery after traumatic SOF tends to plateau after 6 months and, when no bony compression is present, often resolves within 3 to 4 months.…”

“…Cranial nerve recovery after traumatic SOF tends to plateau after 6 months and, when no bony compression is present, often resolves within 3 to 4 months. 31,33 Treatment of SOF syndrome includes systemic steroids to aid in resolution of edema; outcomes appear to be improved with higher dose administration. 31,33,34 Decompression should be considered when there is bony impingement on the SOF.…”

“…31,33 Treatment of SOF syndrome includes systemic steroids to aid in resolution of edema; outcomes appear to be improved with higher dose administration. 31,33,34 Decompression should be considered when there is bony impingement on the SOF. The risks of surgery are considerable and include additional hemorrhage and further cranial nerve injuries that could lead to vision loss.…”