Craniofacial Fracture with Superior Orbital Fissure Syndrome Resulting in Pupil-sparing Oculomotor Nerve Palsy

Hiroshi Taniguchi, Hiroshi Nishioka, Erika Kuriyama, Yoshikazu Inoue, Takayuki Okumoto

Research output: Contribution to journalArticlepeer-review


Superior orbital fissure syndrome (SOFS) is a rare complication of craniofacial fracture, caused by damage to cranial nerves , , , and , which typically is associated with ophthalmoplegia, blepharoptosis, pupil dilatation and fixation, and upper eyelid and forehead hypesthesia. However, we here describe a very unusual case of craniofacial fracture with SOFS in the absence of pupil symptoms, involving a patient who was injured when he fell while riding his bicycle. Upon medical examination, we observed mild blepharoptosis and ophthalmoplegia of the right eye without pupillary symptoms. Computed tomography (CT) revealed basal skull and zygomatic fractures. After the patient had been treated conservatively for his skull base fracture, facial bone reduction was performed at our hospital. Because ophthalmoplegia and blepharoptosis remained after the surgery, we checked the preoperative CT images again and discovered stenosis of the superior orbital fissure. Postoperative CT revealed a widening of the superior orbital fissure after the facial bone reduction, and therefore, the patient was given steroid treatment without additional surgery. At 6 months postoperatively, the cranial nerves had completely recovered. Our finding emphasizes that, in contrast to common theory, trauma-induced SOFS can result in pupil-sparing oculomotor nerve palsy.

Original languageEnglish
Pages (from-to)E5828
JournalPlastic and Reconstructive Surgery - Global Open
Issue number5
Publication statusPublished - 17-05-2024

All Science Journal Classification (ASJC) codes

  • Surgery


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