Traumatic Orbital Apex Syndrome: An Uncommon Sequela of Facial Trauma

Orbital apex syndrome (OAS) is a rare ocular complication following craniomaxillofacial trauma. This traumatic syndrome is a combination of features seen in both superior orbital fissure syndrome and traumatic orbital neuropathy due to nerve impingement. Due in part to the rarity of this disorder, the optimal treatment of traumatic OAS has yet to be determined. We present a case in which traumatic OAS was caused by direct compression due to a displaced fracture segment from the superior orbit. The patient was successfully treated with a combination of emergent decompression and urgent reconstruction suggesting that this may be an effective strategy in OAS resulting from direct nerve compression as a result of craniomaxillofacial fracture.

Orbital apex disorders: Imaging findings and management

Orbital apex disorders include orbital apex syndrome, superior orbital fissure syndrome and cavernous sinus syndrome. These disorders result from various etiologies, including trauma, neoplastic, developmental, infectious, inflammatory as well as vascular causes. In the past, these have been described separately based on anatomical locations of disease process; however, these three disorders share similar causes, diagnostic evaluation and management strategies. The etiology is diverse and management is directed to the causative process. This imaging review summarizes the pertinent anatomy of the orbital apex and illustrates representative pathological processes that may affect this region. The purpose of this review is to provide an update on the current status of diagnostic imaging and management of patients with orbital apex disorders.

Superior orbital fissure syndrome after facial trauma

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.

Superior orbital fissure syndrome caused by an internal carotid artery aneurysm in the cavernous sinus

This article describes the case of superior orbital fissure syndrome caused by an internal carotid artery aneurysm in the cavernous sinus. Etiology, clinical presentations, and diagnostic methods are discussed. Possible regression of signs and symptoms after timely endovascular treatment of an internal carotid artery aneurysm in the cavernous sinus is reported.

Superior Orbital Fissure Syndrome in Lateral Orbital Wall Fracture: Management and Classification Update

The superior orbital fissure syndrome (SOFS) is an uncommon complication rarely occurring in association with craniofacial trauma. Work-up of a patient injured by a traumatic right orbitozygomatic complex fracture and SOFS is presented. Accurate computed tomography scan and three-dimensional reconstruction showed a medial displacement of the lateral orbital wall, compressing the right superior orbital fissure (SOF), without intraorbital bone fragment displacement or hemorrhage. Imaging also revealed a frontosphenotemporal fracture, according to Pellerin et al, that is, frequently associated with visual impairment. Our primary choice of therapy was a corticosteroid treatment in association with an early surgical approach. It consisted in en bloc reduction and osteosynthesis of the fracture through a bicoronal approach, recovering SOF size. A prompt and almost complete recovery of the abducens movement, without diplopia, was achieved in 1 week. The authors discuss indications and management of SOFS. The presence of fractures should urgently lead to surgery. We deny waiting for a medical treatment result, while preferring the prompt reduction of the fractures and extrication of the soft tissues. The main focus of this study is on patient's anatomical feature and fracture patterns.