[Post-traumatic anosmia: description of a clinical case, proposal of a standardized protocol and medico-legal comments].
Man's olfactory perception is considerably limited compared to that of other animals; this sense is, however, extremely important in our social lives: it helps us to "savour" our food, it enables us to appreciate perfumes and, even more important, to pick up smells that signal a danger, such as a gas leak or a fire. We describe the clinical case of a patient with anosmia and hypogeusia that appeared immediately after suffering a concussive head injury. We go through the diagnostic protocol for medico-legal assessment of hypoanosmias previously described in the literature, which includes a clinical and an imaging section. In 9% of all anosmic patients, a traumatic event precedes the onset of the disorder, with repercussions on the olfactory channels and centres of the peripherical and/or central nervous system. The overall rate of anosmia following head injury is estimated to be around 7.5%. Among the principal causes of anosmia, those of medico-legal interest constitute 35% of the total. On the basis of our personal experience and of clinical studies conducted by other Authors, we propose that a bioptic investigation of the olfactory mucosa be added to the existing protocol. The olfactory neuroepithelium of patients suffering from post-traumatic anosmia, in fact, evidences some characteristic degenerative aspects. In conclusion, we report several comments regarding the quantification of the reduction of the olfactory function in different areas of medico-legal interest.
Miani
C
C
Dipartimento di Scienze Chirurgiche, Clinica ORL, Università di Udine. cmiani@uniud.it
Bracale
A M Bergamin
AM
Moreschi
C
C
Codarini
M
M
Ortolani
F
F
D000328:Adult; D006259:Craniocerebral Trauma / Q000150:complications* / Q000473:pathology; D005260:Female; D005554:Forensic Medicine / Q000331:legislation & jurisprudence*; D006801:Humans; D008279:Magnetic Resonance Imaging; D000857:Olfaction Disorders / Q000175:diagnosis / Q000209:etiology*; D009831:Olfactory Mucosa / Q000473:pathology; D012107:Research Design