What is the difference between fissure and foramen

Important differentials to distinguish from superior orbital fissure syndrome are as follow see Table 1 :. The management of superior orbital fissure syndrome depends on its etiology. Treatment is not standardized because relatively few cases have been documented. Reported treatment options include medical and surgical intervention, as well as observation alone [34]. Indications for urgent intervention are vascular causes requiring embolization and bony fractures with displaced fragments or severe foraminal narrowing [3] , particularly lateral orbital wall fractures [35].

Cases involving neoplasms, physical impingement, infections, or retrobulbar hemorrhage warrant the use of surgical exploration. If the superior orbital fissure is compressed or narrowed by a facture, surgical decompression may be beneficial [34] [35]. Surgical management in the non-urgent setting is performed at an average of Both orbital and cranial extradural approaches have been described including extranasal intraorbital to access the lateral wall, extranasal transethomoidal to access the medial wall, a modified extranasal intraorbital route, transtemporal route in causes of infectious collections and combined orbital and cranial for deep decompressions [36] [37] [38].

A concomitant facial fracture can be surgically reduced [34]. Historical treatment of restricted movement due to edema has focused on conservative management and careful observation because spontaneous improvement had been documented in the past.

However, if there is no evidence of bone dislocation, and thus no need for urgent surgical intervention, conservative medical treatment involving megadoses of corticosteroids has proven effective [34] [35].

In cases of retroorbital hematoma, hemorrhage generally resorbs spontaneously after weeks. However, some authors recommend intervention if the hematoma is associated with fractures, such as aspiration, open reduction, or intravenous steroids [34].

Cases of carotid-cavernous sinus fistula can be confirmed with carotid angiography and treated via detachable balloon or coil embolization [34]. Conservative treatment through observation alone has been suggested due to the operative difficulty and risk of further injury from surgical exploration.

Spontaneous recovery, both complete and partial, of motor and sensory function has been reported in cases of traumatic etiology [41]. A recent literature review documented nineteen cases of superior orbital fissure syndrome secondary to craniofacial trauma treated with observation alone, with complete spontaneous recovery in eight of the cases [34].

No adverse effects from medical therapy with high dose steroids in this setting have been described [33]. Recovery is usually extended over a period of months with progress plateauing at 6 months. The abducens nerve which is most commonly damaged shows the best recovery.

Possible sequelae from superior orbital fissure syndrome may include remaining deficit requiring further strabismus or ptosis surgery [3] [5]. Create account Log in. Main page. Getting Started. Recent changes. View form. View source. Jump to: navigation , search. Enroll in the Residents and Fellows contest. Enroll in the International Ophthalmologists contest. Residents and Fellows contest rules International Ophthalmologists contest rules.

Original article contributed by :. Vannessa Leung, MD. All contributors:. Assigned editor:. Claudia Prospero Ponce, MD. Superior Orbital Fissure Syndrome.

Superior orbital fissure syndrome and its mimics: What the radiologist should know? Orbital apex syndrome. Current opinion in ophthalmology. Traumatic superior orbital fissure syndrome: assessment of cranial nerve recovery in 33 cases. Plastic and reconstructive surgery. Walsh and Hoyt's clinical neuro-ophthalmology. Vol 1.

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Verify now. Toggle navigation. Institutional subscriptions support Language. Keep me signed in. This canal transmits the hypoglossal nerve [ XII ]. This is a large opening within the floor of the cranial cavity. The largest foramen within the skull conveys significant structures such as:. This foramen also transmits the ascending spinal accessory nerve [ XI ] and dural veins. German pathologist Hans Chiari described a number of brainstem and inferior cerebellar irregularities. Chiari type I malformations commonly arise from calvarial abnormalities and result in the displacement of the cerebellar tonsils through the foramen magnum.

Chiari type II malformations are characterised by displacement of the medulla , fourth ventricle , as well as the cerebellum , through the foramen magnum. Chiari type II malformations are usually due to a small posterior fossa and are almost always associated with myelomeningocoele. Both types I and II malformations result in varying degrees of herniation displacement of the aforementioned structures into the upper cervical spinal cord. Some common symptoms due to compression of the brainstem include:.

Treatment is guided by the anatomical irregularity. For example, surgical decompression via sub-occipital craniectomy and C1 laminectomy is used to achieve foramen magnum decompression. You can purchase a licence for the Complete Anatomy software we use in our videos here we also get a percentage of your purchase fee if you use this link. Clinical Examination.

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