Superior Orbital Syndrome is one of the compartmental syndromes of orbit which may occur due to trauma.

1. Superior Orbital Fissure
Syndrome
Dr Rudraprasad Chakraborty
1st Year PG Student
Department of Oral & Maxillofacial Surgery
Rama Dental College Hospital And Research Centre
Kanpur, UP
04/04/15

2. • Introduction
• The Syndromes
• The SOFS
• Related Anatomy
• Classification of SOFS
• Clinical Features
• Paathophysiology of C/F ( in White Board)
Inclusions

4. Introduction
Midface fractures on a high level in combination with
orbital wall fractures can cause serious mechanical
and neurogenic ophthalmologic complications
Based on the neurological deficits, different orbital
syndromes can be distinguished

5. The Syndromes
• Partial or complete superior orbital fissure
syndrome
• Retrobulbar hemorrhagic compression
syndrome
• Orbital apex syndrome
• Clivus syndrome

6. Frequency
The frequency of orbital syndromes in complex midface
fractures is approximately 8% (Hardt and Sgier 1991).
Superior orbital fissure syndrome (SOFS) 2.2%
Hemorrhagic-compression syndrome (HCS) 2.2%
Nervus opticus syndrome (NOS) 1.9%
Orbital apex syndrome (OAS) 1.6%
Sinus cavernosus syndrome (SCS)

7. 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.

8. The Anatomy

19. Muscles of Eyelid

23. The 3rd CN

24. Functions of ocular muscles

25. The SOF and Annular ring of Zinn

26. The Peripheral Nerves

27. Le Fort’s Line of Fracture

28. Biomechanical vectors in midface
trauma
1 Complex central
midface fracture/central naso-
orbito-ethmoidal fracture,
2. cranio-orbital
fracture/frontobasal fracture,
3 complex lateral midface
fracture

29. Complete & Incomplete SOFS
Complete SOFS : when all the cranial nerves
entering through the SOF are involved.
Incomplete SOFS : when any of the cranial
Nerves ( generally CN VI) is spared

30. The Complete SOFS
The complete SOFS results from a paresis of the cerebral
nerves III, IV, and VI.
Clinically there is an ophthalmoplegia with ptosis and an
exophthalmus due to disruption of the venous drainage
In addition, a mydriasis and an accommodation paralysis
(cycloplegia) occur due to loss of the parasympatic
innervation

31. Complete right upper orbital fissure syndrome
with palsy of cranial nerves III, IV, and VI following
lateral midface fracture and fracture of the
greater wing of the sphenoid (6-weeks post
surgery)

32. Anesthesia in the areas of sensory innervation is
inevitable if the sensory branches of the ophthalmic
nerve and Nasociliary Nerve are involved.
A severe retroorbital pain sometimes occurs in
combination with a supraorbital neurogenic pain as a
result of the complex damage that has occurred
………………. (Hardt and Sgier 1991).

33. Incomplete SOFS
Due to the fact that three oculomotor nerves enter through the
superior orbital fissure, injuries to the individual branches may
lead to a selective paresis, so developing the image of a partial
SOFS.
Complete SOFS Incomplete SOFS

35. Let us nevigate in CNS…
White Board Please