To Smell or Not to Smell…

Posted on September 10, 2012 in Rhinoplasty

Among the amazing features and functions of the nose, in the world of plastic surgery we frequently overlook the sense of SMELL. As a nose specialist, I have worked with many patients suffering from smell-loss (called hyposmia if the sense is present but reduced, and anosmia if all meaningful sense of smell is gone). This deficit is not as debilitating as the loss of vision or hearing, nor is it as easily apparent to others around us. Rather, anosmia carries with it a unique burden and very real detriment in quality of life – diminishing our relationship with food, with our intimate partners, and even with our memories. I recently came across a short documentary film made by a sufferer of anosmia, and it was captivating. Jacob LaMendola, an independent filmmaker, created this piece, and it can be found in the Op-Docs archives on the New York Times website (www.nytimes.com/video).

Interestingly, the loss of smell does not only affect quality of life in an Epicurian sense, but can also detect and predict neurological diseases before the hallmark symptoms develop. Elegant neuroscience research has shown that olfaction (processing of smells) works a little differently than the other four senses (vision, hearing, touch, and taste). It turns out that the olfactory nerves (nerve endings, or fillae) are directly linked to the memory processing circuitry in the basal forebrain; whereas other sensory input follows a much longer path (it’s sent to the thalamus first, and then to the cerebral cortex, and finally to “memory areas”).

This direct, intimate relationship between smell and memory is corroborated by our everyday experiences – just ask Marcel Proust, who famously wrote about this in Remembrance of Things Past. (Remember that cake that your grandmother used to make? One whiff takes you immediately back to her kitchen.) For this same reason, the loss of olfaction correlates with a loss of the “memory areas” and other specialized neurons in the forebrain (frontal lobe). As such, standardized smell tests have been employed in early diagnosis of diseases like Alzheimer’s, Parkinson’s, and other degenerative disorders.

Another way that a person can lose their sense of smell has to do with the anatomy and function of the nose. In order to smell, you need two things: working neurons (see above) and airflow through the nose. There are lots of reasons why the nasal airway may become obstructed – some of these are “medical” diseases (upper respiratory infection, allergies, sinusitis), but others may be amenable to surgery. For patients who have had trauma to the nose (e.g., a softball to the face, a right hook, a motor vehicle accident, etc.), there may be an anatomic obstruction from a fractured nasal septum or nasal bones. In other patients, their nasal structure (cartilage and skin) may be such that the air passageways are too narrow or collapse even with normal breathing. In each of these cases, a surgical cure may be possible. This is achieved through septoplasty or functional rhinoplasty. You can check out more information on these procedures on our website.

Dr. Ransom

Dr. Evan Ransom is an Ivy League-educated and Ivy League trained Facial Plastic and Reconstructive Surgeon. He is a Double Board Certified Head and Neck Surgeon and Facial Plastic and Reconstructive Surgery and fellowship-trained in facial plastic, reconstructive, and laser surgery. His practice is in the San Francisco Bay Area, serving patients from San Francisco, Oakland, Marin County, Palo Alto, Silicon Valley, Walnut Creek, the East Bay, and all over Northern California.