The superior orbital fissure is a

foramen In anatomy and osteology, a foramen (;Entry "foramen"
in

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

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.

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

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 ...

(CN IV), recurrent meningeal branch of

(anastomotic branch of

with the

) *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.

References

External links

* * () (#2) {{Authority control Foramina of the skull Medical mnemonics

Structure

Contents

Clinical significance

Superior orbital fissure syndrome

See also

References

External links