Imaging And Clinical Study Of Traumatic Superior Orbital Fissure Syndrome

Japanese scholar Nakagawa first proposed the concept of "traumatic superior orbital fissure syndrome" in 1974.He found that some traumatic brain injury patients with superior orbital fissure fractures had special ocular symptoms and it is the same as or similar to the clinical manifestations of "superior orbital fissure syndrome" caused by vascular,developmental and other factors reported in the past,which are mainly the damage of the oculomotor nerve,the trochlear nerve,the abducens nerve and the trigeminal nerve that pass through the superior orbital fissure.The traumatic superior orbital fissure syndrome is a rare complication of craniocerebral trauma.With the improvement of the overall treatment of traumatic brain injury,the overall mortality of traumatic superior orbital fissure syndrome is gradually decreased,but the high morbidity remains medical workers are faced with the important issues.In this study,the traumatic superior orbital fissure syndrome is considered as the object of study,divided into the following two parts,imaging study of the superior orbital fissure width and clinical research on traumatic superior orbital fissure syndrome.Part ?: A statistical analysis on the width of the superior orbital fissure in Chineseadults by head CT plain scanPurpose: To analyze the size of superior orbital fissure in Chinese adults who had undergone emergency CT scan in the past year and to compare the size of the superior orbital fissure.We hope that by skimming the patient's superior orbital fissure size statistics to provide the average size of Chinese adults' superior orbital fissure.For our hospital and the national treatment of patients with superior orbital fissure syndrome and delayed superior orbital fissure syndrome to provide a more reasonable reference and avoid delayed orbital fissure syndrome.Methods: The width of left and right superior orbital fissure in 151 patients with mild traumatic brain injury was measured by CT plain scan.The superior orbital fissure is a relatively stereoscopic structure that exhibits different widths at different levels when examined by CT plain scan.Therefore,we select the optic canal level to measure the width of the superior orbital fissure.Results: In all adult Chinese skull CT examination,the average width of the superior orbital fissure on both sides was 3.48 ± 1.33 mm,the average width of the left superiororbital fissure was 3.92 ± 1.67 mm,and the average width of the right superior orbital fissure was 3.48 ± 1.33 mm.In male patients,the mean width of the superior orbital fissure on both sides was 3.86 ± 1.47 mm,the average width of the left superior orbital fissure was4.08 ± 1.57 mm,and the average width of the right superior orbital fissure was 3.64 ± 1.34 mm.In female patients,the average width of the superior orbital fissure on both sides was3.55 ± 1.55 mm,the average width of the left superior orbital fissure was 3.77 ± 1.74 mm,and the average width of the right superior orbital fissure was 3.33 ± 1.32 mm.Conclusions: There was no significant difference between male and female in the average width of the both sides' superior orbital fissures.There was no significant difference in the width of superior orbital fissure between ages.The mean width of the orbital fissure in adult Chinese is similar to the average size of superior orbital fissure reported in previous foreign literature.Through previous literature and current studies show that: We should accept the inference that congenital stenosis of superior orbital fissure is the risk of delayed superior orbital fissure syndrome.Surgeons should therefore take the necessary precautions during perioperative periods in patients with congenital stenosis of superior orbital fissure to prevent the development of delayed superior orbital fissure syndrome after surgery.Part ?.Clinical study of traumatic superior orbital fissure syndromePurpose: Traumatic superior orbital fissure syndrome is a rare complication of craniofacial trauma.The clinical manifestations of traumatic superior orbital fissure syndrome are mainly due to cranial nerve palsy caused by oculomotor nerve,trochlear nerve,abducens nerve and trigeminal nerve.This research mainly evaluated patients with traumatic superior orbital fissure syndrome who underwent assessment of the recovery of cranial nerve function after surgical treatment and conservative treatment.Methods: A total of 26 patients with traumatic brain injury were identified as traumatic superior orbital fissure in all patients with traumatic brain injury from July 2012 to July 2017 in our Emergency treatment.The degree of cranial nerve injury and the degree of functional recovery in patients with traumatic superior orbital fissure syndrome are mainly evaluated by the degree of extraocular muscle movement.The mean cranial nerve function was evaluated on the 6th day after traumatic brain injury with an average follow-up of 12.3 months.Results: A total of 26 patients.The average age was 41.5 ± 12.1 years.The main cause of traumatic brain injury was motor vehicle accidents(76.9%).Six patients underwent conservative treatment,including the use of hormone therapy and neurotrophic drugs,hyperbaric oxygen therapy and 20 patients underwent superior orbital fissure decompression.When the cranial nerves were initially evaluated after traumatic brain injury,the abducens nerve was most damaged and the oculomotor nerve injury was the lightest.At the site of follow-up at the third month after injury,the extent of the abducens nerve function recovery was greatest.At the 9th month of follow-up,there was the least extent of recovery of abducens nerve function and the largest recovery of the function of the trochlear nerve.Patients with traumatic superior orbital fissure syndrome have a major period of recovery of cranial nerve function in the first 6 months after traumatic brain injury.Conclusion: In patients with traumatic superior orbital fissure syndrome,the trochlear nerve is the least damaged and the abducens nerve is the most damaged.Functional recovery of cranial nerves peaked 6 months after injury,and cranial nerves recovered more slowly after 6 months.When patients with traumatic superior orbital fissure syndrome have evidence of cranial nerves associated with fracture compression or when there is greater cranial nerve dysfunction,we recommend the treatment of superior orbital fissure decompression surgery.