Successful Decompression and Reduction of Displaced Sphenoid Wing Fracture into the Superior Orbital Fissure Causing Complete Ophthalmoplegia Secondary to Compression of Cranial Nerves III, IV, and VI.

Superior orbital fissure syndrome (SOFS) is a rare, vision-threatening condition caused by injury or compression of cranial nerves III, IV, and VI. We report a 16-year-old male who sustained extensive craniofacial trauma, including a displaced left sphenoid wing fracture, after a motorized scooter accident. Initially, he had limited extraocular motility, but by hospital day 5, he developed complete ophthalmoplegia due to progressive nerve compression. Urgent surgical decompression of the superior orbital fissure and reduction of the fracture were performed via a pterional craniotomy on day 7. Postoperatively, the patient experienced full restoration of ocular motility and pupillary function, with no complications. This case highlights the potential for delayed neurological deterioration in sphenoid wing fractures and emphasizes the importance of close serial examination and timely operative intervention once SOFS develops, demonstrating that even delayed intervention can result in complete neurological recovery.