Depending on the inflammatory infiltrate location, patients might present with various nonspecific symptoms that include nerve compression in cavernous sinus, partial or complete ophthalmoplegia indicating superior orbital fissure
involvement, or loss of vision indicating optic nerve involvement; isolated trochlear nerve paresis has also been described (4).
This condition might be explained by the high invasion potential of the non-specific granulomatous inflammation located in the cavernous sinus, superior orbital fissure
, or orbital apex.
A retained wood penetrating the superior orbital fissure
in a neurologically intact child.
Specific diagnostic criteria have been recommended by the International Headache Society which includes unilateral headache; granulomatous inflammation of the cavernous sinus and superior orbital fissure
or orbit seen on magnetic resonance imaging or biopsy; paresis of one or more of the ipsilateral third, fourth, and/or sixth cranial nerves; evidence of causation demonstrated by both headache preceded by oculomotor paresis by less than 2 weeks or developed with it and headache that is localized around the ipsilateral brow and eye; and symptoms not better accounted for by an alternative diagnosis .
Neuroradio- diagnostic examinations showed that orbital cellulitis had greatly reduced into inflammation in the orbital apex, superior orbital fissure
and cavernous sinus on the right side (Figure-1, 2).
The intracranial extension has been described through the three major openings in the posterior aspect of the orbit, which include the superior orbital fissure
, optic canal and the inferior orbital fissure.
in the anterior part of the cavernous sinus it rises and passes through the superior orbital fissure
above and lateral to the annulus of Zinn.
Knowing the precise location of the optic strut and its variations are very important while analyzing CT images, since it represents a valuable landmark in proper evaluation and differentiation of the optic canal, superior orbital fissure
and anterior clinoid process on coronal and axial scans .
Tolosa-Hunt syndrome (THS) is a rare disorder indicated by recurrent painful ophthalmoplegia caused by non-specific inflammation of the cavernous sinus or superior orbital fissure
If the penetration is parallel to the orbital roof, it will violate the cranium through the superior orbital fissure
or optic canal, and usually does not result in bone fracture.
Finally, the nerves converge and acquire protective support from the thick fibrous meningeal layer (dura) as they pass together through the cavernous sinus (see Figure 2 and textbox), before entering the orbit via the superior orbital fissure
(SOF) to reach their destinations.
9) Geraghty and Dolan reported that the complete diagnostic criteria for MSH are (1) enlargement of the vertical orbit, (2) enlargement of the superior orbital fissure
, (3) elevation of the canine fossa, (4) enlargement of the pterygopalatine fissure, and (5) lateralization of the infraorbital neurovascular canal.