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.

Received: 01 October 2025

Accepted after revision: 31 December 2025

Accepted Manuscript online:
23 April 2026

Article published online:
11 May 2026

© 2026. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/).

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