Head and Neck
Bobby Krishnachetty, Abdul Syed, Harriet Scott in Applied Anatomy for the FRCA, 2020
There are a total of nine foramina or fissures within the orbit. The most important are shown in Figure 1.6. Optic foramen Optic nerve, ophthalmic arterySuperior orbital fissure (see also Scalp and Base of Skull) Oculomotor, trochlear, abducens nerves, ophthalmic division (V1) of trigeminal nerveSuperior and inferior ophthalmic veinsInferior orbital fissure Infra-orbital nerve (branch from maxillary division (V2) of trigeminal nerve) and vessels
Orbital Fractures
Jeffrey R. Marcus, Detlev Erdmann, Eduardo D. Rodriguez in Essentials of CRANIOMAXILLOFACIAL TRAUMA, 2014
Superior orbital fissure syndrome results from fracture line extension into the superior orbital fissure and subsequent injury to cranial nerves III, IV, VI, and the ophthalmic branch of the trigeminal nerve. Symptoms include ophthalmoplegia, ptosis of the upper lid, proptosis, a fixed and dilated pupil, loss of corneal reflex, and sensory loss in the distribution of V1. Orbital apex syndrome results from ischemic optic neuropathy caused by fracture extension into the optic foramen or retrobulbar hematoma. It is similar to superior orbital fissure syndrome, with the distinction that the optic nerve is involved in orbital apex syndrome. A swinging light source moving from one pupil to the other can detect whether a relative afferent pupillary defect is present and can be performed in even an unconscious patient. This test is used to detect optic nerve impingement at the orbital apex; an abnormal result reveals no indirect light reaction of the unaffected eye (Marcus Gunn pupil). Visual evoked potential testing can be employed to confirm unclear results. If it occurs postoperatively, an emergent CT scan is performed, followed by operative exploration.
Orbital resection and reconstruction
John Dudley Langdon, Mohan Francis Patel, Robert Andrew Ord, Peter Brennan in Operative Oral and Maxillofacial Surgery, 2017
The orbit is a pear-shaped bony chamber with an anterior opening measuring approximately 40 and 35 mm in horizontal and vertical diameters, respectively. Its volume expands approximately 1 cm posterior to the bony orbital rim and then gradually decreases towards the apex, which consists of the optic canal at its narrowest diameter. In the axial plane, the medial wall measures approximately 45–50 nm from the anterior lacrimal crest to the optic canal. Posteriorly, the lateral wall is bordered with the superior orbital fissure, situated between the greater and lesser wings of the sphenoid bone. This foramen transmits the third, fourth and sixth cranial nerves and the ophthalmic branch of the fifth cranial nerve, the superior orbital vein and sympathetic nerves.
Accelerated growth of orbital schwannomas during pregnancy does not correlate with sex hormone- or growth factor receptor status
Published in Orbit, 2021
G. J. Hötte, N. Meijer, R. M. Verdijk, D. Paridaens
Most orbital schwannomas originate from the ophthalmic division of the trigeminal nerve and are commonly located in the superior orbit due to the nerve distribution pattern.2,3 It presents unilaterally, although there has been one report of bilateral orbital schwannoma.4 When small they are asymptomatic, but usually tend to grow over months to years, causing a slowly progressive exophthalmos and inferior displacement.3,5 Other clinical symptoms are also aspecific and include diplopia and motility disorders, visual loss, scotomas and eyelid swelling.3 Although they are usually painless, a deep, dull pain or sensibility disorder may occur in the distribution of the affected nerve.3 Schwannomas are predominantly benign, and reported cases of malignant transformation are controversial.5 Also, intracranial extension, most commonly through the superior orbital fissure, can occur.2
Combined neurosurgical and orbital intervention for spheno-orbital meningiomas - the Manchester experience
Published in Orbit, 2020
J. Young, F. Mdanat, A. Dharmasena, P. Cannon, B. Leatherbarrow, C. Hammerbeck-Ward, S. Rutherford, S. Ataullah
Spheno-orbital meningiomas (SOMs) are complex, slow-growing tumours that represent up to 9% of intracranial meningiomas.1–3 SOMs have characteristic clinical and morphological features. They generally originate from the sphenoid wing dura, and have distinctive periorbital involvement. They are comprised of two components: intraosseous growth with associated hyperostosis and a widespread, intradural, soft-tissue component that is often thin and carpet-like.4–8 The hyperostosis typically involves the sphenoid ridge, and the lateral and superior orbital walls. This can adversely affect adjacent important structures including the superior orbital fissure (SOF), the optic canal, and the anterior clinoid process. The soft-tissue component can expand into and involve extracranial compartments, including the orbit and its contents. These intraosseous, intra-orbital, and intradural changes result in the typical clinical features seen in patients with SOMs, such as proptosis, cranial nerve palsy and visual dysfunction.6,8
Preoperative embolization of suprasellar hemangioblastoma supplied by artery of foramen rotundum: a case report and review of the literature
Published in British Journal of Neurosurgery, 2023
Sungjun Moon, Hui Joong Lee, Subum Lee
Preoperative embolization may provide a useful option for reducing tumor hypervascularity but the procedure is not straightforward when the calibers of feeding arteries are small as was the case here on the right.3 On the left, angiography showed the AFR main feeder with a distinctive corkscrew shape. The AFR branches from the distal IMA, passes through the foramen rotundum, and connects to anterolateral branches of the inferolateral trunk, itself a branch of the internal carotid. So the AFR forms a potential anastomosis between the ECA and ICA.4 In addition, the presence of the artery of superior orbital fissure is also important. This artery arises at the distal IMA, either singly or from a common trunk with AFR, and then runs upward to reach the superior orbital fissure and anastomose with the anteromedial branch of the inferolateral trunk or the ophthalmic artery.5 Reflux of embolic material, therefore, carries risks of blindness or parenchymal embolic infarction, and we recommend preoperative AFR embolization is performed with proper mixtures of Histoacryl and Lipiodol under continuous fluoroscopy to avoid complications.
Related Knowledge Centers
- Abducens Nerve
- Oculomotor Nerve
- Ophthalmic Nerve
- Skull
- Sphenoid Bone
- Trochlear Nerve
- Sympathetic Nervous System
- Lesser Wing of Sphenoid Bone
- Greater Wing of Sphenoid Bone
- Ophthalmic Veins