Superior orbital fissure

The superior orbital fissure is a foramen or cleft in the skull. It lies between the lesser and greater wings of the sphenoid bone. It allows for many structures to pass, including the oculomotor nerve, the trochlear nerve, the ophthalmic nerve, the abducens nerve, the ophthalmic vein, and sympathetic fibres from the cavernous plexus.

Superior orbital fissure
Orbit seen from the front, with bones labeled in different colors, and superior orbital fissure at center as an "hour-glass" formation.
1 Foramen ethmoidale, 2 Canalis opticus, 3 Fissura orbitalis superior, 4 Fossa sacci lacrimalis, 5 Sulcus infraorbitalis, 6 Fissura orbitalis inferior, 7 Foramen infraorbitale
Details
Part ofsphenoid bone
Systemskeletal
Identifiers
Latinfissura orbitalis superior
TA98A02.1.05.023
A02.1.00.083
TA2488
FMA54799
Anatomical terms of bone

Structure
Superior orbital fissure.

The superior orbital fissure lies between the lesser and greater wings of the sphenoid bone.[1] It is between the optic canal (in front) and the foramen rotundum (behind).[1]

Structures passing through

A number of important anatomical structures pass through the fissure, and these can be damaged in orbital trauma, particularly blowout fractures through the floor of the orbit into the maxillary sinus. These structures are:

It is divided into 3 parts from lateral to medial:

Variation

The superior orbital fissure is usually 22 mm wide in adults.[1]

Clinical significance

The abducens nerve is most likely to show signs of damage first, with the most common complaints retro-orbital pain and the involvement of cranial nerves III, IV, V1, and VI without other neurological signs or symptoms. This presentation indicates either compression of structures in the superior orbital fissure or the cavernous sinus.

Superior orbital fissure syndrome

Superior orbital fissure syndrome, also known as Rochon-Duvigneaud's syndrome,[4][5] is a neurological disorder that results if the superior orbital fissure is fractured. Involvement of the cranial nerves that pass through the superior orbital fissure may lead to diplopia, paralysis of extraocular muscles, exophthalmos, and ptosis. Blindness or loss of vision indicates involvement of the orbital apex, which is more serious, requiring urgent surgical intervention. Typically, if blindness is present with superior orbital syndrome, it is called orbital apex syndrome.

See also

References
  1. Weinzweig, Jeffrey; Taub, Peter J.; Bartlett, Scott P. (2010). "46 - Fractures of the Orbit". Plastic Surgery Secrets Plus (2nd ed.). Chicago: Mosby. pp. 299–307. doi:10.1016/B978-0-323-03470-8.00046-6. ISBN 978-0-323-03470-8.
  2. Barral, Jean-Pierre; Crobier, Alain (2009-01-01). "9 - Manipulation of the plurineural orifices". Manual Therapy for the Cranial Nerves. Churchill Livingstone. pp. 51–57. doi:10.1016/B978-0-7020-3100-7.50012-4. ISBN 978-0-7020-3100-7.{{cite book}}: CS1 maint: date and year (link)
  3. Patel, Swetal (2015). "20 - The Oculomotor Nerve". Nerves and Nerve Injuries. Vol. 1: History, Embryology, Anatomy, Imaging, and Diagnostics. Academic Press. pp. 305–309. doi:10.1016/B978-0-12-410390-0.00021-4. ISBN 978-0-12-410390-0.
  4. synd/3387 at Who Named It?
  5. A. Rochon-Duvigneaud. Quelques cas de paralysie de tous les nerfs orbitaires (ophthalmoplegie totale avec amaurosse en anesthésie dans le domaine de l’ophthalmique d’origine syphilitique). Archives d'ophthalmologie, Paris, 1896, 16: 746-760.
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