title: Delayed Superior Orbital Fissure Syndrome After Reconstruction of Blowout Fracture.
abstract: The superior orbital fissure syndrome (SOFS) has been known to be a condition caused by impairment of the nerves that cross the superior orbital fissure. Traumatic SOFS is an uncommon complication which occurs usually within 48 hours after a facial injury. A 25-year-old male sustained facial trauma following an altercation. Clinical findings on presentation included swelling, ecchymosis, hyphema, subretinal hemorrhage, and mild extraocular movement limitation upon lateral gaze on his right eyelids. Facial computed tomography scan confirmed fractures of the medial walls of the right orbit and herniation of orbital soft tissue without the incarceration of medial rectus muscle. Ten days after the trauma, the operation was performed. On postoperative day 16, the patient showed ptosis of the right upper eyelid with a fixed pupil, and there was a hypoesthesia over the distribution of the right supraorbital and supratrochlear nerves. The authors diagnosed as a delayed SOFS and prescribed 4 mg of methylprednisolone q.i.d. for 30 days. After steroid therapy, extraocular movement limitations improved progressively. After 8 months, movement was completely restored. The authors experienced delayed SOFS on posttrauma day 27, and it was treated by steroid therapy. Surgical intervention is required when there is an evident etiology such as underlying hematoma or plate migration. If the reason is not clear like our case, steroid therapy can be considered as one of the options. Particularly, the authors should give special attention to the patient who has congenitally narrow superior orbital fissure, like Fujiwara et al suggested.
authors.affiliation: Department of Plastic and Reconstructive Surgery, Sanggye Paik Hospital, Inje University College of Medicine, Seoul, South Korea.
authors.forename: Young Joon
authors.initials: YJ
authors.lastname: Kim
authors.forename: Woong Kyu
authors.initials: WK
authors.lastname: Choi
mesh_terms: D020222:Abducens Nerve Injury / Q000209:etiology; D000328:Adult; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D001763:Blepharoptosis / Q000209:etiology; D020209:Cranial Nerve Injuries / Q000209:etiology*; D005938:Glucocorticoids / Q000627:therapeutic use; D006547:Hernia / Q000000981:diagnostic imaging; D006801:Humans; D008297:Male; D008775:Methylprednisolone / Q000627:therapeutic use; D009295:Nasal Bone / Q000293:injuries; D009408:Nerve Compression Syndromes / Q000209:etiology*; D015835:Ocular Motility Disorders / Q000209:etiology; D009915:Orbit / Q000294:innervation*; D009917:Orbital Fractures / Q000000981:diagnostic imaging / Q000601:surgery*; D011183:Postoperative Complications; D019651:Plastic Surgery Procedures / Q000379:methods*; D012887:Skull Fractures / Q000000981:diagnostic imaging; D014057:Tomography, X-Ray Computed / Q000379:methods; D061247:Trochlear Nerve Injuries / Q000209:etiology
chemical_list: D000893:Anti-Inflammatory Agents; D005938:Glucocorticoids; D008775:Methylprednisolone