Traumatic superior orbital fissure syndrome: assessment of cranial nerve recovery in 33 cases.
BACKGROUND
Superior orbital fissure syndrome is a rare complication that occurs in association with craniofacial trauma. The characteristics of superior orbital fissure syndrome are attributable to a constellation of cranial nerve III, IV, and VI palsies. This is the largest series describing traumatic superior orbital fissure syndrome that assesses the recovery of individual cranial nerve function after treatment.


METHODS
In a review from 1988 to 2002, 33 patients with superior orbital fissure syndrome were identified from 11,284 patients (0.3 percent) with skull and facial fractures. Severity of cranial nerve injury and functional recovery were evaluated by extraocular muscle movement. Patients were evaluated on average 6 days after initial injury, and average follow-up was 11.8 months.


RESULTS
There were 23 male patients. The average age was 31 years. The major mechanism of injury was motorcycle accident (67 percent). Twenty-two received conservative treatment, five were treated with steroids, and six patients underwent surgical decompression of the superior orbital fissure. After initial injury, cranial nerve VI suffered the most damage, whereas cranial nerve IV sustained the least. In the first 3 months, recovery was greatest in cranial nerve VI. At 9 months, function was lowest in cranial nerve VI and highest in cranial nerve IV. Eight patients (24 percent) had complete recovery of all cranial nerves. Functional recovery of all cranial nerves reached a plateau at 6 months after trauma.


CONCLUSIONS
Cranial nerve IV suffered the least injury, whereas cranial nerve VI experienced the most neurologic deficits. Cranial nerve palsies improved to their final recovery endpoints by 6 months. Surgical decompression is considered when there is evidence of bony compression of the superior orbital fissure.
Chen
Chien-Tzung
CT
Taipei and Kaohsiung, Taiwan; and Philadelphia, Pa. From the Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital at Linkou, Chang Gung University; Division of Plastic Surgery, University of Pennsylvania; Center for Biostatistics, Chang Gung University; and Division of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital at Kaohsiung, Chang Gung University.
Wang
Theresa Y
TY
Tsay
Pei-Kwei
PK
Huang
Faye
F
Lai
Jui-Pin
JP
Chen
Yu-Ray
YR
D000293:Adolescent; D000328:Adult; D002648:Child; D020209:Cranial Nerve Injuries / Q000175:diagnosis / Q000209:etiology / Q000628:therapy; D003391:Cranial Nerves / Q000502:physiology*; D019299:Decompression, Surgical / Q000379:methods*; D005147:Facial Bones / Q000293:injuries*; D005260:Female; D005500:Follow-Up Studies; D005592:Fracture Fixation / Q000379:methods; D005938:Glucocorticoids / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009408:Nerve Compression Syndromes / Q000175:diagnosis / Q000209:etiology / Q000628:therapy*; D020127:Recovery of Function; D012189:Retrospective Studies; D012887:Skull Fractures / Q000150:complications* / Q000175:diagnosis / Q000601:surgery; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D055815:Young Adult
D005938:Glucocorticoids