Superior orbital fissure

The superior orbital fissure is a foramen in the skull, although strictly it is more of a cleft, lying between the lesser and greater wings of the sphenoid bone.

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Structures passing through

A number of important anatomical structures pass through the fissure, and these can be damaged in orbital trauma, particularly blowout fractures through the floor of the orbit into the maxillary sinus. These structures are:

• superior and inferior divisions of oculomotor nerve (III)
• trochlear nerve (IV)
• lacrimal, frontal and nasociliary branches of ophthalmic nerve (V1)
• abducens nerve (VI)
• superior ophthalmic vein
• sympathetic fibers from cavernous plexus

Perhaps inevitably, a ribald mnemonic has been dreamt up by medical students:^[1] "Lazy French Tarts Sit Naked In Anticipation Of Sex" - for Lacrimal, Frontal, Trochlear, Superior Division of Oculomotor, Nasociliary, Inferior Division of Oculomotor, Abducens nerves, Ophthalmic vein, Sympathetic nerves.

Pathology

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.

Superior orbital fissure syndrome

Superior orbital fissure syndrome, also known as Rochon-Duvigneaud's syndrome, 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, paralysis of extraocular motions, exophthalmos, and ptosis. Blindness or loss of vision indicates involvement of the orbital apex, which is more serious, requiring urgent surgical intervention.

See also

• Foramina of skull

Additional images

References