Complete Unilateral Ophthalmoplegia Due to Primary Carcinoma of the Sphenoidal Sinus

ANEOPLASTIC, inflammatory or traumatic process which involves1 the structures passing through the sphenoidal (superior orbital) fissure and the optic canal may result in pressure on these structures and cause an ophthalmoplegia. The condition has been described in the literature as the apex-sphenoid fissure syndrome. The important structures which pass through the sphenoidal fissure are the third, fourth and sixth cranial nerves ; the three branches of the ophthalmic division of the fifth nerve; the ophthalmic vein; the orbital branch of the middle meningeal artery (when it does not pass through the middle meningeal foramen) and the sympathetic fibers from the cavernous plexus; the sympathetic root of the ciliary ganglion, and (sometimes) the sensory root of the ciliary ganglion. In a roentgenographic study of 370 cases by Guidotti,1the sphenoidal fissure was found to show many anatomic variations, and he stated that it is not always possible to distinguish satisfactorily