Bone: Superior orbital fissure
1 Foramen ethmoidale, 2 Canalis opticus, 3 Fissura orbitalis superior, 4 Fossa sacci lacrimalis, 5 Sulcus infraorbitalis, 6 Fissura orbitalis inferior, 7 Foramen infraorbitale
Dissection showing origins of right ocular muscles, and nerves entering by the superior orbital fissure.
Latin	fissura orbitalis superior
Gray's	subject #201 900

The superior orbital fissure is a foramen in the skull, although strictly it is more of a cleft, lying between the lesser and greater wings of the sphenoid bone.

[edit] Structures passing through

A number of important anatomical structures pass through the fissure, and these can be damaged in orbital trauma, particularly blowout fractures through the floor of the orbit into the maxillary sinus. These structures are:

• superior and inferior divisions of oculomotor nerve (III)
• trochlear nerve (IV)
• lacrimal, frontal and nasociliary branches of ophthalmic nerve (V₁)
• abducens nerve (VI)
• superior and inferior divisions of ophthalmic vein
• sympathetic fibers from cavernous plexus

These include nonvisual sensory messages, such as pain, or motor nerves. They also serve as vascular connections. ^[1]

Human skull from front and behind with calvarium removed. White area in posterior of orbital cavity is the superior orbital fissure.

Perhaps inevitably, a ribald mnemonic has been dreamt up by medical students:^[2] "Lazy French Tarts Sit Naked In Anticipation Of Sex" - for Lacrimal, Frontal, Trochlear, Superior Division of Oculomotor, Nasociliary, Inferior Division of Oculomotor, Abducens nerves, Ophthalmic vein, Sympathetic nerves.

It is divided into 3 parts from lateral to medial: Lateral Part transmits: lacrimal nerve, frontal nerve, trochlear nerve, meningeal branch of lacrimal artery, anastomotic branch of middle meningeal artery which anastomoses with recurrent branch of the lacrimal artery Middle Part transmits: Upper and lower divisions of the oculomotor nerve, nasociliary nerve between the two divisions of oculomotor nerve and abducent nerve Medial Part transmits: Superior ophthalmic vein and sympathetic nerves from the plexus around internal carotid artery

[edit] Pathology

The abducens nerve is most likely to show signs of damage first, with the most common complaints retro-orbital pain and the involvement of cranial nerves III, IV, V1, and VI without other neurological signs or symptoms. This presentation indicates either compression of structures in the superior orbital fissure or the cavernous sinus.

[edit] Superior orbital fissure syndrome

Superior orbital fissure syndrome, also known as Rochon-Duvigneaud's syndrome, ^[3][4] is a neurological disorder that results if the superior orbital fissure is fractured. Involvement of the cranial nerves that pass through the superior orbital fissure may lead to diplopia, paralysis of extraocular motions, exophthalmos, and ptosis. Blindness or loss of vision indicates involvement of the orbital apex, which is more serious, requiring urgent surgical intervention.

[edit] See also

• Foramina of skull

[edit] Additional images

Sphenoid bone. Upper surface.

Sphenoid bone. Upper and posterior surfaces.

The skull from the front.

[edit] References

[edit] External links

• SUNY Figs 22:02-04
• lesson3 at The Anatomy Lesson by Wesley Norman (Georgetown University) (orbitforamina) (#2)
• cranialnerves at The Anatomy Lesson by Wesley Norman (Georgetown University) (V)
• Roche Lexicon - illustrated navigator, at Elsevier 34256.000-1
• Roche Lexicon - illustrated navigator, at Elsevier 34257.000-2