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 Lesser, from Eliezer (, "Help/Court of my God"), is a surname. Notable people with the surname include: * Adolf Lesser (1851–1926), German physician * Aleksander Lesser (1814–1884), Polish painter and art critic * Anton Lesser (born 1952), Br ...

and greater wings of the

sphenoid bone The sphenoid bone is an unpaired bone of the neurocranium. It is situated in the middle of the skull towards the front, in front of the basilar part of the occipital bone. The sphenoid bone is one of the seven bones that articulate to form the o ...

. It gives passage to multiple structures, including the

oculomotor nerve The oculomotor nerve, also known as the third cranial nerve, cranial nerve III, or simply CN III, is a cranial nerve that enters the orbit through the superior orbital fissure and innervates extraocular muscles that enable most movements of ...

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 extraocu ...

ophthalmic veins Ophthalmic veins are veins which drain the eye. More specifically, they can refer to: * Superior ophthalmic vein * Inferior ophthalmic vein The inferior ophthalmic vein is a vein of the orbit that - together with the superior ophthalmic vein - ...

, and sympathetic fibres from the cavernous plexus.

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 ea ...

, and nasociliary branches of ophthalmic nerve (CN V₁) * abducens nerve (CN VI) * superior ophthalmic vein and superior division of the inferior ophthalmic vein * 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, frontal nerve,

(CN IV), recurrent meningeal branch of

(anastomotic branch of

with the

) *Middle part transmits: Superior and inferior divisions of the

(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 extraocula ...

*Medial part transmits: Inferior ophthalmic veins and sympathetic nerves arising from the plexus that accompanies the

internal carotid artery The internal carotid artery (Latin: arteria carotis interna) is an artery in the neck which supplies the anterior circulation of the brain. In human anatomy, the internal and external carotids arise from the common carotid arteries, where these ...

Clinical significance

A multiple

anatomical Anatomy () is the branch of biology concerned with the study of the structure of organisms and their parts. Anatomy is a branch of natural science that deals with the structural organization of living things. It is an old science, having it ...

structures pass through the fissure, and can be damaged in orbital trauma, particularly

blowout fracture An orbital blowout fracture is a traumatic deformity of the orbital floor or medial wall that typically results from the impact of a blunt object larger than the orbital aperture, or eye socket. Most commonly, the inferior orbital wall, or the flo ...

s 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

sign A sign is an object, quality, event, or entity whose presence or occurrence indicates the probable presence or occurrence of something else. A natural sign bears a causal relation to its object—for instance, thunder is a sign of storm, or ...

s of damage first, with the most common complaints retro-orbital

pain Pain is a distressing feeling often caused by intense or damaging stimuli. The International Association for the Study of Pain defines pain as "an unpleasant sensory and emotional experience associated with, or resembling that associated with, ...

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

fracture Fracture is the separation of an object or material into two or more pieces under the action of stress. The fracture of a solid usually occurs due to the development of certain displacement discontinuity surfaces within the solid. If a displ ...

d. 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 Paralysis (also known as plegia) is a loss of motor function in one or more muscles. Paralysis can also be accompanied by a loss of feeling (sensory loss) in the affected area if there is sensory damage. In the United States, roughly 1 in 5 ...

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