Traumatic superior orbital fissure syndrome: Review of literature and report of three cases
A 20-year-old female reported with a chief complaint of pain and swelling on the left half of the face and inability to open her left eye. She had suffered injury few hours back when a rotatory machine belt reportedly broke and directly hit the left side of her face with high impact. Her left half of the face was swollen with complete ptosis of the left eye []. There was proptosis, periorbital edema, and ecchymosis, but no subconjunctival hemorrhage. The left pupil was fixed and dilated with vision intact and there was complete absence of movement of eyeball in all the gazes []. On further ophthalmic examination, there was loss of corneal reflex, loss of direct light reflex, presence of consensual reflex, and loss of accommodation reflex. Ophthalmic consultation was done and fundoscopic findings were normal. On palpation, there was depression and tenderness over the zygomatic arch region with tenderness at the fronto-zygomatic suture and the infraorbital rim. There was paresthesia over the left forehead, but sensation over the left infraorbital nerve distribution was normal. Her mouth opening was reduced (2.0 cm) with tenderness at the zygomatic buttress region intraorally. An occipito-mental view of skull showed generalized opacification of the left maxillary sinus with fracture of the zygomatic bone. A CT scan showed marked proptosis of the left eye with no intraconal or extraconal hemorrhage. There was fracture and mild buckling in of the lateral wall of the orbit. The medial wall and the ethmoidal sinuses were uninvolved []. A diagnosis of fracture of left zygomatic bone with SOFS was made. The patient was managed conservatively with megadose steroid and anti-inflammatory drugs. There was partial improvement in the ptosis, proptosis, and ophthalmoplegia after 2 weeks, after which reduction of the fracture without fixation was done intraorally under local anesthesia. Intraoperative check was maintained for any aggravation of signs and symptoms (e.g., an acute pain in retrobulbar region). The mouth opening improved intraoperatively. The patient was followed at regular interval and her condition improved over the period with mild ptosis still persistent at the end of 8 weeks. The patient was lost to further follow-ups.