SUPERIOR ORBITAL FISSURE SYNDROME ASSOCIATED WITH FACIAL TRAUMA: CASE REPORT

Abstract

Superior orbital cleft syndrome is a complex of signs and symptoms developed from damage to noble vascular and neurological structures that are found in the orbital cavity, more precisely in the region of the superior orbital fissure. The objective of this study is to report a case of superior orbital cleft syndrome after facial trauma, detailing and discussing the therapy adopted, as well as the challenges of surgical treatment. A 31-year-old male patient, melanoderma, victim of physical aggression, presented to the emergency room of the General Hospital of the State of Bahia, with facial trauma caused by physical aggression. Oral and maxillofacial physical examination revealed preserved facial contours in the upper and lower thirds of the face, bone steps in frontozygomatic and infraorbital rim regions, facial flattening in the malar region on the left, visual acuity preserved bilaterally, extrinsic orbicularis motricity preserved in the right eye and presence of total ophthalmoplegia in the left eye, exophthalmosis, periorbital ecchymosis and upper eyelid ptosis in the left eye,  pupil in the left eye was not photoreactive, nasal bones and maxillae were stable, there was no mobility atypical to the manipulation of the mandible, partial edentulism in both arches, and stable dental occlusion. hypoesthesia in the frontal and infraorbital regions, both on the left. Facial computed tomography showed fractures of the orbitozygomatic-maxillary complex (MCOC), roof and floor of the orbit, all on the left, as well as the presence of bone synthesis material in an appropriate position in the region of the left mandibular angle resulting from previous facial trauma treatment. The proposed surgical treatment was osteosynthesis of the orbitozygomatic-maxillary complex and conservative treatment of roof and floor fractures of the orbit, which was successfully performed by the oral and maxillofacial surgery and traumatology team. In the postoperative period, the patient had a good evolution without significant clinical complications, and remains under clinical follow-up to the present day. Thus, the present study highlights the importance of accurate diagnosis and appropriate treatment of this syndrome, emphasizing the need for an individualized therapeutic approach, considering the signs and symptoms and the risks involved. Therefore, it is essential for the professional to know about the clinical presentation and etiological factors of this condition to avoid possible diagnostic errors and the use of inappropriate forms of treatment so that health, function and aesthetics can be returned to these patients.