TRAUMATIC SUPERIOR ORBITAL FISSURE SYNDROME - A CASE REPORT

Abstract

The superior orbital apex syndrome is a relatively uncommon complication of midface maxillofacial trauma. The clinical symptoms consist in ophthalmoplegia, palpebral ptosis, exophthalmia, fixed mydriasis, retrobulbar pain and supraorbital nerve hypoesthesia by involvement of the third (oculomotor nerve), fourth (trochlear), fifth (trigeminal) and sixth nerve (abducens). If there is involvement of the optical nerve, the syndrome is termed - orbital apex syndrome. In this article, we will present the case of a 33-years old male, victim of human aggression with traumatic superior orbital apex syndrome. We discuss details of diagnosis and surgical treatment. We will make, also, a review of literature on this subject. Even if the actual therapeutic algorithm is currently a matter of controversy, the generally accepted therapy plane initiated with a high dose of corticosteroids. Fine slice CT scan examination is mandatory for the correct planning. If the CT scan reveals a highly displaced maxillo-zygomatic complex fracture with or without orbital blow-out fracture, we recommend early surgical intervention after the resolving of the periorbital hematoma within 5 to 10 days ideally if concomitant intracranial injury or other conditions permit it. The early restoration of the orbital anatomy and volume will create the basis for cranial nerve decompression and function at the level of superior orbital fissure.