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Isolated fracture of the superior orbital fissure
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British Journal of Oral and Maxillofacial Surgery 48 (2010) 178–179
Short communication
Isolated fracture of the superior orbital fissure K.H. Taylor a,∗ , K.D. Mizen a,1 , N. Spencer b a b
Department of Oral and Facial Specialties, Pinderfields General Hospital, Aberford Road, Wakefield WF1 4DG, West Yorkshire, United Kingdom Department of Radiology, Pinderfields General Hospital, Aberford Road, Wakefield WF1 4DG, West Yorkshire, United Kingdom
Accepted 11 June 2009 Available online 22 August 2009
Abstract We report a case of a patient with an isolated fracture of the superior orbital fissure and development of superior orbital fissure syndrome. © 2009 The British Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved. Keywords: Superior orbital fissure; Fracture; Orbital trauma
Introduction The superior orbital fissure is a narrow cleft that links the orbit and cavernous sinus of the middle cranial fossa. It is a functionally important structure located between the greater and lesser wings of the body of the sphenoid bone, and has the oculomotor, trochlear, nasociliary, and abducent nerves, the three branches of the ophthalmic nerve, the orbital branch of the meningeal artery, the recurrent meningeal branch of the lacrimal artery, ophthalmic veins, and sympathetic fibres running through it.1 Coincident damage to the optic foramen and optic nerve is termed orbital apex syndrome.2 Superior orbital fissure syndrome is caused by compression or disruption3 of the contents of the superior orbital fissure and presents as ophthalmoplegia, ptosis, pain, fixed dilated pupil, proptosis, hypofunction of the lacrimal nerve, and anaesthesia of the forehead, upper eyelid, bridge of nose and cornea. Common causes include neoplasia, inflammation, or trauma often associated with concurrent craniofacial fractures. We report the case of a patient with an isolated fracture of the superior orbital
∗
Corresponding author. Tel.: +44 01924 212961; fax: +44 01924 212904. E-mail addresses: [email protected] (K.H. Taylor), [email protected] (K.D. Mizen), [email protected] (N. Spencer). 1 Tel.: +44 01924 212961; fax: +44 01924 212904.
fissure, and development of superior orbital fissure syndrome, which to our knowledge has not been reported previously.
Case report An 18-year-old male patient presented to the accident and emergency department of the Mid Yorkshire Hospitals NHS Trust after being assaulted and punched once in his left eye with a knuckleduster. Initial assessment was difficult because he was drunk and uncooperative. He had a 3 cm infraorbital laceration on the left side, was unable to open his eye, and had ophthalmoplegia and dilated pupil, which was reported to be reactive but sluggish in response to light. Visual acuity was recorded as 6/36 compared with 6/6 in the other eye. Plain radiographs were unremarkable but at this stage there was suspicion of a fracture of the orbital floor. He was admitted for fluid resuscitation, neurological and ocular assessment, and further investigations. Computed tomography (CT) showed a comminuted fracture of the greater wing of the sphenoid that formed the lateral wall of the superior orbital fissure; a small bony fragment had been displaced medially into the fissure, and most of the bony displacement had occurred laterally (Figs. 1 and 2). The fracture was remote from the optic canal, anterior clinoid, and lesser wing of sphenoid. CT showed minimally displaced
0266-4356/$ – see front matter © 2009 The British Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.
doi:10.1016/j.bjoms.2009.06.230
K.H. Taylor et al. / British Journal of Oral and Maxillofacial Surgery 48 (2010) 178–179
179
nasal bones and no evidence of any other bony injury. The fracture was treated conservatively, and postoperative review after 4 weeks showed improvement in visual acuity of the left eye (6/6 compared with 6/18), but no improvement of symptoms of superior fissure syndrome. We continue to monitor his progress.
Discussion
Fig. 1. Coronal computed tomogram showing isolated fracture of the left superior orbital fissure.
This was an unusual injury as the isolated fracture of the superior orbital fissure was seen on CT but not on plain radiographs. CT was done as we suspected a fracture of the orbital floor. In ‘simple’ trauma cases, CT would not be done routinely, but this case highlights the requirement for it in trauma cases where other craniofacial fractures are suspected.
References 1. Williams P, Bannister L. Gray’s anatomy. 38th ed. Edinburgh: Churchill Livingstone; 1995. p. 1355. 2. Kjoer I. A case of orbital apex syndrome in collateral pansinusitis. Acta Ophthalmol 1945;23:357. 3. Pogrel MA. The superior orbital fissure syndrome: report of a case. J Oral Surg 1980;38:215–7.
Fig. 2. Axial computed tomogram showing isolated fracture of the left superior orbital fissure.
British Journal of Oral and Maxillofacial Surgery 48 (2010) 178–179
Short communication
Isolated fracture of the superior orbital fissure K.H. Taylor a,∗ , K.D. Mizen a,1 , N. Spencer b a b
Department of Oral and Facial Specialties, Pinderfields General Hospital, Aberford Road, Wakefield WF1 4DG, West Yorkshire, United Kingdom Department of Radiology, Pinderfields General Hospital, Aberford Road, Wakefield WF1 4DG, West Yorkshire, United Kingdom
Accepted 11 June 2009 Available online 22 August 2009
Abstract We report a case of a patient with an isolated fracture of the superior orbital fissure and development of superior orbital fissure syndrome. © 2009 The British Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved. Keywords: Superior orbital fissure; Fracture; Orbital trauma
Introduction The superior orbital fissure is a narrow cleft that links the orbit and cavernous sinus of the middle cranial fossa. It is a functionally important structure located between the greater and lesser wings of the body of the sphenoid bone, and has the oculomotor, trochlear, nasociliary, and abducent nerves, the three branches of the ophthalmic nerve, the orbital branch of the meningeal artery, the recurrent meningeal branch of the lacrimal artery, ophthalmic veins, and sympathetic fibres running through it.1 Coincident damage to the optic foramen and optic nerve is termed orbital apex syndrome.2 Superior orbital fissure syndrome is caused by compression or disruption3 of the contents of the superior orbital fissure and presents as ophthalmoplegia, ptosis, pain, fixed dilated pupil, proptosis, hypofunction of the lacrimal nerve, and anaesthesia of the forehead, upper eyelid, bridge of nose and cornea. Common causes include neoplasia, inflammation, or trauma often associated with concurrent craniofacial fractures. We report the case of a patient with an isolated fracture of the superior orbital
∗
Corresponding author. Tel.: +44 01924 212961; fax: +44 01924 212904. E-mail addresses: [email protected] (K.H. Taylor), [email protected] (K.D. Mizen), [email protected] (N. Spencer). 1 Tel.: +44 01924 212961; fax: +44 01924 212904.
fissure, and development of superior orbital fissure syndrome, which to our knowledge has not been reported previously.
Case report An 18-year-old male patient presented to the accident and emergency department of the Mid Yorkshire Hospitals NHS Trust after being assaulted and punched once in his left eye with a knuckleduster. Initial assessment was difficult because he was drunk and uncooperative. He had a 3 cm infraorbital laceration on the left side, was unable to open his eye, and had ophthalmoplegia and dilated pupil, which was reported to be reactive but sluggish in response to light. Visual acuity was recorded as 6/36 compared with 6/6 in the other eye. Plain radiographs were unremarkable but at this stage there was suspicion of a fracture of the orbital floor. He was admitted for fluid resuscitation, neurological and ocular assessment, and further investigations. Computed tomography (CT) showed a comminuted fracture of the greater wing of the sphenoid that formed the lateral wall of the superior orbital fissure; a small bony fragment had been displaced medially into the fissure, and most of the bony displacement had occurred laterally (Figs. 1 and 2). The fracture was remote from the optic canal, anterior clinoid, and lesser wing of sphenoid. CT showed minimally displaced
0266-4356/$ – see front matter © 2009 The British Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.
doi:10.1016/j.bjoms.2009.06.230
K.H. Taylor et al. / British Journal of Oral and Maxillofacial Surgery 48 (2010) 178–179
179
nasal bones and no evidence of any other bony injury. The fracture was treated conservatively, and postoperative review after 4 weeks showed improvement in visual acuity of the left eye (6/6 compared with 6/18), but no improvement of symptoms of superior fissure syndrome. We continue to monitor his progress.
Discussion
Fig. 1. Coronal computed tomogram showing isolated fracture of the left superior orbital fissure.
This was an unusual injury as the isolated fracture of the superior orbital fissure was seen on CT but not on plain radiographs. CT was done as we suspected a fracture of the orbital floor. In ‘simple’ trauma cases, CT would not be done routinely, but this case highlights the requirement for it in trauma cases where other craniofacial fractures are suspected.
References 1. Williams P, Bannister L. Gray’s anatomy. 38th ed. Edinburgh: Churchill Livingstone; 1995. p. 1355. 2. Kjoer I. A case of orbital apex syndrome in collateral pansinusitis. Acta Ophthalmol 1945;23:357. 3. Pogrel MA. The superior orbital fissure syndrome: report of a case. J Oral Surg 1980;38:215–7.
Fig. 2. Axial computed tomogram showing isolated fracture of the left superior orbital fissure.