Manual of Surgery Volume Second: Extremities—Head—Neck. Sixth Edition.Thomson, Alexis
Science
Manual of Surgery Volume Second: Extremities—Head—Neck. Sixth Edition.
Thomson, Alexis
Surgery
I. The branches of the _Olfactory Nerve_ may be ruptured as they pass
through the cribriform plate in fractures implicating the anterior
fossa of the skull, and there results complete and permanent loss of
smell (_anosmia_). Hæmorrhage into the nerve sheath or contusion of
the nerve may cause a transitory loss of smell. The trunk of the nerve
may be implicated also in tumours and meningitis in the anterior
fossa. In all cases in which anosmia results there is also
interference with the power of recognising different flavours, thus
greatly impairing the sense of taste.
II. _Optic Nerve._--Temporary paralysis of one or both optic nerves is
a comparatively common result of traumatic effusion of blood into
their sheaths; the resulting blindness may pass off in a few days, or
may last for some weeks. When a large effusion takes place, the
prolonged pressure on the nerve may result in optic atrophy and
permanent blindness. Complete severance of the nerve by a bullet, the
point of a sharp instrument, or a fragment of bone, results in loss of
sight in the eye on the same side. In cellulitis of the orbit,
intra-orbital tumour, gumma and aneurysm in the region of the
cavernous sinus, also, the optic nerve may be implicated.
Lesions implicating the cortical centre for sight in the occipital
lobe give rise to hemianopia--that is, loss of sight in the lateral
halves of the fields of vision of both eyes--colour-blindness,
subjective sensations of light and colour, and other eye symptoms.
Double optic neuritis, followed by optic atrophy, is one of the most
constant effects of the growth of a tumour within the skull, and is
not uncommon in cases of cerebral abscess and meningitis. Pressure on
the optic chiasma, for example by a tumour of the pituitary body, is
associated with bilateral temporal hemianopsia.
III. _Oculo-Motor Nerve._--One or more of the branches of this nerve
may be compressed by extravasated blood, or be contused and lacerated
in fractures implicating the region of the sphenoidal fissure. Fixed
dilatation of one pupil may result from pressure by blood-clot,
without other functional disturbance of the nerve. A tumour or an
aneurysm growing in this region also may press upon the nerve.
Sometimes both nerves are involved--for example, in fracture
implicating both sides of the anterior fossa, and in tumours,
particularly gumma, growing in the region of the floor of the third
ventricle. In lesions of the cerebral hemispheres the third nerve is
frequently paralysed. Its cortical centre lies in close proximity to
the centre for the face (Fig. 179).
The most prominent symptoms of complete paralysis are ptosis or
drooping of the upper eyelid, lateral strabismus, and slight downward
rotation of the eye with diplopia. There are also dilatation of the
pupil from paralysis of the circular fibres of the iris, and loss of
accommodation and reaction to light from paralysis of the ciliary
muscle.
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