Resident Manual of Trauma to the Face, Head and Neck

but possible (Figure 3.17). Rupture of the globe is also a rare, but devastating, injury.

Figure 3.17 Dislocated lens seen displaced to inferior portion of anterior chamber of the globe.

f. Imbalance Imbalance may be present in patients with NOE injuries, primarily in patients with serious trauma to the face that can cause a concussion, anterior skull base contusion, cerebral edema, or injury to the medial longitudinal fasciculus. Contrecoup injuries to the brainstem and vestibular/cerebellar pathways may have occurred; these signs are ominous for more serious intracranial pathology. Nystagmus may be a feature of contrecoup trauma. g. Anosmia Anosmia is another worrisome sign. If the patient fails to perceive the smell of common scents, such as soap or alcohol, further investigation is warranted. The cause may simply be an accumulation of blood, mucus, and swollen nasal membranes, but could also be due to a disruption of the olfactory nerve at the level of the cribriform plate. If this injury is suspected, the patient should be tested for CSF rhinorrhea, using filter paper in the front-leaning-head position or collected and tested for beta-2 transferrin.

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