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British Journal of Oral and Maxillofacial Surgery 53 (2015) 92–93
Short communication
Abnormal anatomy of inferior orbital fissure and herniation
of buccal fat pad
T. Aldridge ∗ , A. Thomson, V. Ilankovan
Poole Hospital NHS Foundation Trust, United Kingdom
Accepted 24 September 2014
Available online 22 October 2014
Abstract
The anatomy of the inferior orbital fissure has been well studied, and its reported dimensions vary little. It is encountered during exploration
of the orbital floor and when possible is not disturbed. We describe a case of herniation of buccal fat through the inferior orbital fissure that
was found during exploration and repair of the orbital floor.
© 2014 The British Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.
Keywords: Inferior orbital fissure; Orbital floor fracture; Buccal fat pad
Anatomy
The buccal fat pad is an encapsulated mass of specialised fatty
tissue. It is located between the buccinator and masseter, and
the superficial facial muscles, and allows the masticatory and
mimetic muscles to glide. It can be divided into a body and 4
processes, and is fixed by 6 ligaments to the maxilla, posterior
zygoma, temporalis tendon, and the inner and outer aspects
of the inferior orbital fissure.
The inferior orbital fissure transmits the infraorbital and
zygomatic branches of the maxillary nerve, the inferior ophthalmic vessels, and orbital branches of the pterygopalatine
ganglion.
Its length is reported to vary from 25 to 35 mm (mean 29)1
and it lies between the greater wing of the sphenoid bone
laterally and the maxillary and palatine bones medially. The
anterior margin lies between 6 and 10 mm from the inferior
lateral aspect of the infraorbital rim.2,3 Its width has been
reported as a mean (SD) of 1.9 mm (1.3)4 to 5 mm anteriorly,
tapering to 2.4 mm posteriorly.1 It communicates inferiorly
∗
Corresponding author. Tel.: +44 07780682522.
E-mail address: t [email protected] (T. Aldridge).
with the pterygopalatine, infratemporal, and temporal fossas,
and the masticator space.
In 20 dry skulls of unknown ethnic origin, age and sex,
measurements taken (using digital callipers) of the distance
from the anterior edge of the infraorbital margin to the anterior edge of the fissure ranged from 11.3 to 23.0 mm (mean
16.1). The widest anterior measurement ranged from 3.05 to
9.32 mm (mean 5.6).
Case report
A fit and well 21-year-old man with no previous history of
facial trauma presented after an assault. He had sustained a
fracture of the left orbital floor and comminuted fractures of
the nasal bone. Initial diplopia settled but computed tomography (CT) showed entrapment of the inferior rectus muscle. He
was counselled about late onset enophthalmus, and consented
to an operation to explore and repair the orbital floor.
Exploration through a subciliary incision showed the
fracture lateral to the lacrimal groove and medial to the inferior orbital nerve. The trapped muscle was released. Further
lateral dissection showed herniation of fat into or from a large
http://dx.doi.org/10.1016/j.bjoms.2014.09.020
0266-4356/© 2014 The British Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.