Endoscopic Decompression of Supraorbital Fissure Syndrome After Zygomaticomaxillary Fracture

The Superior Orbital Fissure Syndrome (SOFS) is a rare complication after craniofacial trauma. According to Hirschfeld, who first described SOFS in 1858, and Lakke, who further defined the complete SOFS, this syndrome results from damage to structures passing through the superior orbital fissure. The structures passing via the superior orbital fissure include the lacrimal nerve, nasociliary nerve, oculomotor nerve, abducens nerve, superior orbital nerve, trochlear nerve, and superior ophthalmic vein. The symptoms of supraorbital fissure syndrome are ophthalmoplegia, ptosis, extraocular muscle limitation, dilated pupil, and forehead dysesthesia. A retrospective study was performed from July 2010 to July 2017 in 2322 traumatic brain injury patients treated in the department of neurosurgery, Changzheng Hospital. A total of 39 patients with traumatic SOFS were identified based on traumatic history, symptoms, physical examinations, and image findings. According to a former retrospective study in Changzheng Hospital, their surgical decompression of SOFS was performed via orbitozygomatic approach. However, there might be a less invasive surgical approach to treat SOFS. We suggest an unusual surgical approach, the endoscopic transethmoidal approach, which might be one of the useful methods to treat SOFS.