Apr 15, 2015 superior orbital fissure syndrome sofs a group of neurological deficits expressed by the altered functions of nerves passing through the superior orbital fissure due to dislocated bony fragments or comminuted fractures in the region of the superior orbital fissure or of the lesser wing of the sphenoid cause direct nerve lesions. Orbital fissure medical definition merriamwebster medical. Lacrimal nerve frontal nerve trochlear nerve superior division of oculomotor nerve abducens nerve nasociliary nerve branch of ophthalmic nerve. Superior orbital fissure how is superior orbital fissure. Pathological processes in the cavernous sinus can produce an exact imitation of this syndrome.
Superior orbital fissure syndrome is a symptomatologic complex, consisting of retroorbital pain, paralysis of extraocular muscles, impairment of first trigeminal branches and frequent involvement of the optic nerve. Superior orbital fissure syndrome journal of neurology. Orbital apex syndrome is a rare but potentially fatal situation rarely seen initially by ent surgeons. Because of this, the emphasis of the technique is on the medial aspect of the fissure. Superior orbital fissure and orbital apex syndrome as rare complications of herpes zoster. Partial closure of right superior orbital fissure with. Ta a cleft between the greater and the lesser wings of the sphenoid establishing a channel of communication between the middle cranial fossa and the orbit, through which pass the oculomotor and trochlear nerves, the ophthalmic division of the trigeminal nerve, the abducens nerve, and the superior or combined. An important vein travelling the sof is quite constant. Media in category inferior orbital fissure the following 6 files are in this category, out of 6 total. The superior orbital fissure and its contents article pdf available in surgical and radiologic anatomy 2. The superior orbital fissure syndrome, characterized by ophthalmoplegia, ptosis, proptosis of the eye, and dilation and fixation of the pupil, is a very rare condition.
The inferior surface of small wings of sphenoid forms the back part of the roof of the orbit, and the upper boundary of the superior orbital fissure this fissure is of a triangular form, and leads from the cavity of the cranium into that of the orbit. Superior and inferior orbital fissures flashcards quizlet. Superior orbital fissure syndrome sofs is an interesting symptom complex, which poses difficult questions for the treating physicians. Involvement of the cranial nerves that pass through the superior orbital fissure may lead to diplopia, paralysis of extraocular muscles, exophthalmos, and ptosis.
Two bony roots that connect the lesser wing of the sphenoid with the body of the sphenoid form the optic canal. Superior orbital fissure syndrome after facial trauma. Workup of a patient injured by a traumatic right orbitozygomatic complex fracture and sofs is presented. Maxillary division of trigeminal nerve v2 or vb maxillary nerve anatomy medical animations duration.
Introduction the superior orbitary fissure syndrome sofs was described by hirchfield in 18581, and was characterized by ophthalmoplegia, superior palpebral ptosis, eye proptosis, mydriasis and frontal region and superior eyelid anesthesia due to the concurrent or not lesion of the iii, iv and vi cranial pairs, first division of the v cranial pair and autonomic innervation of the eye globe. Superior orbital fissure syndrome is a severe clinical entity characterized by injuries of neurovascular structures passing through the superior orbital fissure. Tsementzis, differential diagnosis in neurology and neurosurgery. We report an even rarer case of an intraorbital extramedullary. Click on image for an enlarged view based on illustration created by patrick j. May 24, 2015 maxillary division of trigeminal nerve v2 or vb maxillary nerve anatomy medical animations duration. This occurs following severe impact causing constriction of the superior orbital fissure. Nerves passing through superior orbital fissure mnemonic. Inferior orbital fissure radiology reference article. Syndromes of the orbital fissure, cavernous sinus, cerebello. Learn vocabulary, terms, and more with flashcards, games, and other study tools.
The structures affected are the contents of the fissure described earlier, namely the lacrimal, frontal, trochlear, superior and inferior branches of the oculomotor nerve, nasociliary, and abducent nerves. Dec 11, 2011 superior orbital fissure syndrome sofs is an interesting symptom complex, which poses difficult questions for the treating physicians. Lynch mnemonic live frankly to see absolutely no insult the nerves passing through superior orbital fissure are from top to bottom. The orbitomeningeal artery is an important landmark marking the tip of the iceberg, with the superior orbital fissure lying beneath. Involvement of the cranial nerves that pass through the superior orbital fissure may lead to diplopia, paralysis of. The fissure and the anterior cavernous sinus contain the same structures, and determining which is involved in the absence of orbital mass signs is dependent on imaging. The term superior orbital fissure syndrome sofs or rochonduvigneaud syndrome is applied to lesions located immediately anterior to the orbital apex, associated with impaired function of the cranial nerves iii, iv, v, and vi that enter the orbit through the sof.
Superior orbital fissure definition at, a free online dictionary with pronunciation, synonyms and translation. The inferior orbital fissure iof lies in the floor of the orbit inferior to the superior orbital fissure and it is bounded superiorly by the greater wing of sphenoid, inferiorly by maxilla and orbital process of palatine bone and laterally by the zygomatic bone. Some remarks on the anatomy of this region should precede a comment on the superior orbital fissure syndrome. Historically, the terms superior orbital fissure, orbital apex, and cavernous sinus have been used to define the anatomic locations of a disease process. The tolosahunt syndrome ths is caused by a granulomatous inflammatory process that involves the anterior cavernous sinussuperior orbital fissure region, and is diagnosed by.
Superior orbital fissure syndrome, also known as rochonduvigneauds syndrome, is a neurological disorder that results if the superior orbital fissure is fractured. Pathological processes around this relatively narrow cleft can give rise to a syndrome which consists of retroorbital pain, paresis of the ocular muscles, and sensory changes in the distribution of the first trigeminal branch. The cavernous sinus syndrome css includes the features of oas with added involvement of the maxillary branch of the trigeminal nerve v2 and oculosympathetic. Superior orbital fissure syndrome sofs a group of neurological deficits expressed by the altered functions of nerves passing through the superior orbital fissure due to dislocated bony fragments or comminuted fractures in the region of the superior orbital fissure or of the lesser wing of the sphenoid cause direct nerve lesions. Superior orbital fissure american academy of ophthalmology. The motor nerves to the eye and the first branch of the trigeminal nerve leave the middle cranial fossa through the superior orbital fissure. The superior orbital fissure and its contents springerlink. Bhanu prakash usmle, fmge and neet pg 128,771 views. Fractures of the apex rarely are isolated because they occur in the association with or as extension of fractures of the facial skeleton, base of skull. The mullers muscle extends for the whole length of the inferior orbital fissure, passes above the maxillary strut and enters the superior orbital fissure. A conservative approach is advocated in this condition unless there is a bony impingement of the neuronal structure andor simultaneous compression of optic nerve leading to blindness or. Ratings 100% 1 1 out of 1 people found this document helpful.
It is straddled by the tendinous ring which is the common origin of the four rectus muscles extraocular muscles gross anatomy boundaries. Subsequent workup revealed a foreign body located within the orbit, passing through the superior orbital fissure and into cavernous. It joins medially with the pterygomaxillary fissure at a right angle. Superior orbital fissure syndrome also known as rochenduvigneaud syndrome is a collection of symptoms caused by compression of structures just anterior to the orbital apex. The tolosahunt syndrome ths is caused by a granulomatous inflammatory process that involves the anterior cavernous sinus superior orbital fissure region, and is diagnosed by excluding other traumatic, infective, vascular, neoplastic, metabolic, and inflammatory causes. According to banks, hirschfeld first described a trauma. The infraorbital vessels are found in the inferior orbital fissure, and travel down the infraorbital groove into the infraorbital canal and exit through the infraorbital foramen.
Zygomaticorbital 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. It is immediately under the periorbit, outside the muscular cone, and reaches the cavernous venous compartment. Topographic landmarks for the superior orbital fissure are useful for general orientation and approach to the middle fossa, cavernous sinus and orbit. The classical features of superior orbital fissure syndrome arise due to compression of all or some anatomical structures passing through the fissure. Superior orbital fissure radiology reference article. The superior orbital fissure syndrome sofs is an uncommon complication rarely occurring in association with craniofacial trauma. Jeanpierre barral, alain croibier, in manual therapy for the cranial nerves, 2009. Superior orbital fissure syndrome is a symptomatologic complex, consisting of retroorbital pain, paralysis of extraocular muscles, impairment of. Cavernous sinus and superior orbital fissure multiple. Optic canal superior orbital fissure inferior orbital. An orbital apex syndrome oas is a syndrome involving the same cranial nerves palsies in association with optic nerve dysfunction. The orbital apex is the most posterior portion of the pyramidalshaped orbit, positioned at the craniofacial junction.
According to banks, 1 hirschfeld first described a trauma patient with the physical sign of sofs in 1858. Superior orbital fissure syndrome sofs also known as rochon duvigneaud syndrome is a rare complication of craniofacial trauma with an orbital fracture that extends to the superior orbital fissure that results in injury to the cranial nerves iii, iv, v ophthalmic branch of the trigeminal nerve and vi as they traverse the fissure into the orbit 1. Start studying superior and inferior orbital fissures. Note that the presence of many nerves and arteries along the lateral side of the optic nerve mandates a superonasal surgical approach to the optic nerve in the. Inferior orbital fissure definition of inferior orbital. Lakke 2 further defined the complete sofs, which consisted of paresis of the ocular muscle, sensory disturbance in the distribution of the first branch of trigeminal nerve, and retroorbital. How can you treat superior orbital fissure syndrome when. Superior orbital fissure syndrome also known as rochenduvigneaud syndrome is a collection of symptoms caused by compression of. Unilateral orbital or periorbital pain associated with paresis of one or more of the iiird, ivth andor vith cranial nerves, caused by a granulomatous inflammation in the cavernous sinus, superior orbital fissure or orbit. Traumatic superior orbital fissure syndrome is a rare complication that occurs in association with craniofacial trauma. Tolosahunt syndrome ths is a rare eye disorder with signs and symptoms such as headaches, eye pain, decreased eye movement, and blurred vision.
Superior orbital fissure syndrome radiology reference. The lateral wall and the floor of the orbit are separated posteriorly by the inferior orbital fissure which transmits the zygomatic branch of the maxillary nerve and the ascending branches from the pterygopalatine ganglion. For claims with a date of service on or after october 1, 2015, use an equivalent icd10cm code or codes. Superior orbital fissure syndrome surgery and treatment. In this study, the microsurgical anatomy and morphometry of the superior orbital fissure and its related structures were examined in 57 disarticulated sphenoid bones, 102 skull bases and 58 adult cadaveric heads. The syndrome is characterized by ophthalmoplegia, ptosis. Traumatic superior orbital fissure syndrome is an uncommon complication of craniomaxillofacial trauma with an incidence of less than 1%. Anatomy the superior orbital fissure is enclosed by the lesser and the greater wing of the sphenoid bone. In the superior orbital fissure the oculomotor nerve runs very medial, accompanied laterally by the abducent nerve and medially by the nasociliary nerve. The tolosahunt syndrome ths is caused by a granulomatous inflammatory process that involves the anterior cavernous sinussuperior orbital fissure region, and is diagnosed by excluding other traumatic, infective, vascular, neoplastic, metabolic, and inflammatory causes.
Jan 24, 2012 superior orbital fissure syndrome gamal sobhy. Which is the most inferior nerve that passes through the superior orbital fissure. The diagnostic value of orbital venography and carotid angiography in the. Subsequent workup revealed a foreign body located within the orbit, passing through the superior orbital fissure and into cavernous sinus, impinging upon the right cavernous carotid artery. A case of superior orbital fissure syndrome is described, with emphasis on the differential diagnosis between it and orbital apex syn drome and traumatic carotid.
Superior orbital fissure syndrome linkedin slideshare. Complicated pansinusitis masquerading orbital apex syndrome. It is straddled by the tendinous ring which is the common origin of the four rectus muscles extraocular muscles. Pdf traumatic superior orbital fissure syndrome is an uncommon complication of craniomaxillofacial trauma with an incidence of less than 1%.
The tolosahunt syndrome ths is caused by a granulomatous inflammatory process that involves the anterior cavernous sinus superior orbital fissure region, and is diagnosed by. Superior orbital fissure definition of superior orbital. Superior orbital fissure syndrome is an infrequently encountered entity with a unique presentation and significant morbidity. Which are the 5th most superior nerves that pass through the superior orbital fissure.
Rbcp superior orbitary fissure syndrome by face trauma. We present the case of a patient who presented with superior orbital fissure syndrome 72 hours following reported trauma to the right eye. The superior orbital fissure syndrome sofsis a very rare condition, especially due to trauma and its therapeutic managements. Cranial nerve iv, the frontal and lacrimal nerves, and the ophthalmic vein enter through the superior orbital fissure and thus lie within the periorbita but outside the muscle cone.
Pdf superior orbital fissure syndrome in lateral orbital. At this point the frontal dura can be dissected free from the roof of the orbit so that the orbital bone is freed from dura on one side and periorbita on the other before performing the orbital osteotomies. Aug 16, 2017 the topic superior orbital fissure syndrome you are seeking is a synonym, or alternative name, or is closely related to the medical condition tolosahunt syndrome. Nov 21, 2014 the mullers muscle extends for the whole length of the inferior orbital fissure, passes above the maxillary strut and enters the superior orbital fissure. Last updated on sun, 12 aug 2012 multiple sclerosis. Involvement of the cranial nerves that pass through the superior orbital fissure may lead to diplopia, paralysis of extraocular motions, exophthalmos, and ptosis.
May 27, 2017 verhaeghe f, villain m, labauge p, daien v 2016 orbital apex syndrome secondary to herpes zoster ophthalmicus. You need to know the nature of the neoplasma generic name saying it is likely cancer but you need to know what kind of cancer it might be. The syndrome is characterized by ophthalmoplegia, ptosis, proptosis of eye, dilation and fixation of the pupil, and anesthesia of the upper eyelid and forehead. All the grooves arose from the lateral end of superior orbital fissure except one on the left that arose from foramen meningoorbitale. In the present case, there were no associated orbital fractures. Involvement of the cranial nerves that pass through the superior orbital fissure may lead to diplopia, paralysis of extraocular motions, exophthalmos. The infraorbital vessels are found in the inferior orbital fissure, and travel down the infraorbital groove into the infraorbital canal and exit through the infraorbital. Feb 11, 2019 the syndrome manifests as hemicranial or periorbital pain, ophthalmoplegia and sensory loss.
The superior orbital fissure syndrome sofs is a complex of impaired function of the cranial nerves iii, iv, v, and vi that enter the orbit through. The superior orbital fissure syndrome results from compression structures that pass this region, resulting in. The superior orbital fissure is the communication between the cavernous sinus and the apex of the orbit. The abducent nerve lies in the medial aspect of the superior orbital fissure between the oculomotor nerve medially and the trochlear nerve laterally fig. The superior orbital fissure is a foramen in the skull, although strictly it is more of a cleft, lying between the lesser and greater wings of the sphenoid bone. The term superior orbital fissure syndrome sofs also called as rochonduvigneaud syndrome is applied to lesions located immediately anterior to the orbital apex, including the structures exiting the annulus of zinn and often those external to the annulus. Superior orbital fissure syndrome karger publishers. It opens into posterolateral aspect of orbital floor.
We apply the technique of opening the osteodura of the fissure, focusing the action on the medial part of the fissure. The superior orbital fissure syndrome sofs is an uncommon complication after craniofacial trauma. Partial closure of right superior orbital fissure with narrow. Sofs can arise from multiple etiologies and mechanisms. There is a specific treatment for each type of cancer. Superior orbital fissure and orbital apex syndrome as rare.
However, the diagnostic evaluation and management is similar for each of these entities. Superior orbital fissure an overview sciencedirect topics. The anatomy of the orbital apex is significant for the complex association between bony, neural, and vascular elements. Key words superior orbital fissure neurological deficits superior orbital fissure syndrome optic canal optic foramen eissn 84038 partial closure of right superior orbital fissure with narrow optic foramen in shape and measured 0.
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