The superior orbital fissure is a
or cleft of the
skull
The skull is a bone protective cavity for the brain. The skull is composed of four types of bone i.e., cranial bones, facial bones, ear ossicles and hyoid bone. However two parts are more prominent: the cranium and the mandible. In humans, th ...
between the
lesser and
greater wings of the
sphenoid bone. It gives passage to multiple structures, including the
oculomotor nerve,
trochlear nerve
The trochlear nerve (), ( lit. ''pulley-like'' nerve) also known as the fourth cranial nerve, cranial nerve IV, or CN IV, is a cranial nerve that innervates just one muscle: the superior oblique muscle of the eye, which operates through the pu ...
,
ophthalmic nerve
The ophthalmic nerve (V1) is a sensory nerve of the face. It is one of three divisions of the trigeminal nerve (CN V). It has three branches that provide sensory innervation to the eye, the skin of the upper face, and the skin of the anterior sc ...
,
abducens nerve
The abducens nerve or abducent nerve, also known as the sixth cranial nerve, cranial nerve VI, or simply CN VI, is a cranial nerve in humans and various other animals that controls the movement of the lateral rectus muscle, one of the extraocul ...
,
ophthalmic veins, and
sympathetic fibres from the
cavernous plexus
The cavernous nerve plexus (also called the Walther plexus) is situated below and medial to that part of the internal carotid artery which is placed by the side of the sella turcica in the cavernous sinus, and is formed chiefly by the medial div ...
.
Structure
![Slide2rome](https://upload.wikimedia.org/wikipedia/commons/3/3e/Slide2rome.JPG)
The superior orbital fissure is usually 22
mm wide in adults,
and is much larger medially. Its boundaries are formed by the (caudal surface of the)
lesser wing of the sphenoid bone, and (medial border of the)
greater wing of the sphenoid bone.
Contents
The superior orbital fissure is traversed by the following structures:
* (superior and inferior divisions of the)
oculomotor nerve (CN III)
*
trochlear nerve (CN IV)
*
lacrimal,
frontal
Front may refer to:
Arts, entertainment, and media Films
* ''The Front'' (1943 film), a 1943 Soviet drama film
* ''The Front'', 1976 film
Music
* The Front (band), an American rock band signed to Columbia Records and active in the 1980s and e ...
, and
nasociliary branches of
ophthalmic nerve (CN V1)
*
abducens nerve (CN VI)
*
superior ophthalmic vein and superior division of the
inferior ophthalmic vein
The inferior ophthalmic vein is a vein of the orbit that - together with the superior ophthalmic vein - represents the principal drainage system of the orbit. It begins from a venous network in the front of the orbit, then passes backwards throu ...
*
sympathetic fibres from the
cavernous nerve plexus
* recurrent meningeal branch of
lacrimal artery
The lacrimal artery is an artery of the orbit. It is a branch of the ophthalmic artery. It accompanies the lacrimal nerve along the upper border of the lateral rectus muscle, travelling forward to reach the lacrimal gland. It supplies the lacri ...
(anastomotic branch of
lacrimal artery
The lacrimal artery is an artery of the orbit. It is a branch of the ophthalmic artery. It accompanies the lacrimal nerve along the upper border of the lateral rectus muscle, travelling forward to reach the lacrimal gland. It supplies the lacri ...
with the
middle meningeal artery
The middle meningeal artery ('' la, arteria meningea media'') is typically the third branch of the first portion of the maxillary artery. After branching off the maxillary artery in the infratemporal fossa, it runs through the foramen spinosum t ...
)
The superior orbital fissure is divided into 3 parts from lateral to medial:
*Lateral part transmits:
superior ophthalmic vein,
lacrimal nerve
The lacrimal nerve is the smallest branch of the ophthalmic nerve (V1), itself a branch of the trigeminal nerve (CN V). The other branches of the ophthalmic nerve are the frontal nerve and nasociliary nerve.
Structure
The lacrimal nerve branche ...
,
frontal nerve
The frontal nerve is the largest branch of the ophthalmic nerve (V1), itself a branch of the trigeminal nerve (CN V). It supplies sensation to the skin of the forehead, the mucosa of the frontal sinus, and the skin of the upper eyelid. It may b ...
,
trochlear nerve
The trochlear nerve (), ( lit. ''pulley-like'' nerve) also known as the fourth cranial nerve, cranial nerve IV, or CN IV, is a cranial nerve that innervates just one muscle: the superior oblique muscle of the eye, which operates through the pu ...
(CN IV), recurrent meningeal branch of
lacrimal artery
The lacrimal artery is an artery of the orbit. It is a branch of the ophthalmic artery. It accompanies the lacrimal nerve along the upper border of the lateral rectus muscle, travelling forward to reach the lacrimal gland. It supplies the lacri ...
(anastomotic branch of
lacrimal artery
The lacrimal artery is an artery of the orbit. It is a branch of the ophthalmic artery. It accompanies the lacrimal nerve along the upper border of the lateral rectus muscle, travelling forward to reach the lacrimal gland. It supplies the lacri ...
with the
middle meningeal artery
The middle meningeal artery ('' la, arteria meningea media'') is typically the third branch of the first portion of the maxillary artery. After branching off the maxillary artery in the infratemporal fossa, it runs through the foramen spinosum t ...
)
*Middle part transmits: Superior and inferior divisions of the
oculomotor nerve (CN III),
nasociliary nerve
The nasociliary nerve is a branch of the ophthalmic nerve, itself a branch of the trigeminal nerve (CN V). It is intermediate in size between the other two branches of the ophthalmic nerve, the frontal nerve and lacrimal nerve.
Structure
The na ...
(lies between the two divisions of oculomotor nerve) and
abducent nerve
The abducens nerve or abducent nerve, also known as the sixth cranial nerve, cranial nerve VI, or simply CN VI, is a cranial nerve in humans and various other animals that controls the movement of the lateral rectus muscle, one of the extraocul ...
*Medial part transmits:
Inferior ophthalmic veins and sympathetic nerves arising from the plexus that accompanies the
internal carotid artery
Clinical significance
A multiple
anatomical structures pass through the fissure, and can be damaged in
orbital trauma, particularly
blowout fractures through the floor of the orbit into the
maxillary sinus
The pyramid-shaped maxillary sinus (or antrum of Highmore) is the largest of the paranasal sinuses, and drains into the middle meatus of the nose through the osteomeatal complex.Human Anatomy, Jacobs, Elsevier, 2008, page 209-210
Structure
It i ...
.
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
The cavernous sinus within the human head is one of the dural venous sinuses creating a cavity called the lateral sellar compartment bordered by the temporal bone of the skull and the sphenoid bone, lateral to the sella turcica.
Structure
The cave ...
.
Superior orbital fissure syndrome
Superior orbital fissure syndrome, also known as Rochon-Duvigneaud's syndrome,
[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.] 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
Diplopia is the simultaneous perception of two images of a single object that may be displaced horizontally or vertically in relation to each other. Also called double vision, it is a loss of visual focus under regular conditions, and is often v ...
,
paralysis of extraocular muscles,
exophthalmos
Exophthalmos (also called exophthalmus, exophthalmia, proptosis, or exorbitism) is a bulging of the eye anteriorly out of the orbit. Exophthalmos can be either bilateral (as is often seen in Graves' disease) or unilateral (as is often seen in ...
, and
ptosis.
Blindness
Visual impairment, also known as vision impairment, is a medical definition primarily measured based on an individual's better eye visual acuity; in the absence of treatment such as correctable eyewear, assistive devices, and medical treatment†...
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
*
Foramina of skull
This article lists foramina that occur in the human body.
__TOC__
Skull
The human skull has numerous openings (foramina), through which cranial nerves, arteries, veins, and other structures pass. These foramina vary in size and number, with ...
*
Inferior orbital fissure
The inferior orbital fissure is formed by the sphenoid bone and the maxilla. It is located posteriorly along the boundary of the floor and lateral wall of the orbit. It transmits a number of structures, including:
* the zygomatic branch of the m ...
References
External links
*
* () (#2)
{{Authority control
Foramina of the skull
Medical mnemonics