Posttraumatic Anosmia and Orbital Frontal Injury
Damage to orbital frontal cortex is common following traumatic brain injury (TBI) and is, therefore, of particular concern in the evaluation of TBI patients. The mechanism of injury typically involves abrasions, lacerations, and contusions to tissue on the inferior aspect of the frontal lobes as a result of contact with the cribriform plate (cf. Gurdjan & Gurdjan, 1976; Jennette & Teasdale, 1981). This rough bony structure, which supports the frontal lobes, has irreverently been referred to as “the dashboard of the brain.” Injury to orbital frontal cortex may have impact on executive functioning, psychosocial competency, ability to maintain employment, and reliable conduct of adult activities in daily living (Damasio, 1979; Lezak, 1978; Martzke, Swan, & Varney, 1991; Stuss & Benson, 1984; Stuss & Gow, 1992; Varney & Menefee, 1993). Thus, the patient with orbital frontal damage, despite having a “mild” head injury (at least from an emergency room perspective), may nevertheless have a catastrophic outcome with very disagreeable life-altering consequences.