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Recent observations from U.S. military involvement in major combat operations in Iraq, counterinsurgency in Afghanistan, and humanitarian assistance in the United States, Haiti, and West Africa provide critical lessons for [...]

An otherwise fit and well 12-year-old girl presented to the otolaryngology clinic with lifelong anosmia. Although she had suffered a nasal injury when she was 4 years old, she was adamant that the deficit pre-dated her injury. Interestingly, her maternal grandfather also complained of this problem.Clinical examination was entirely normal, except for her anosmia. There was no intranasal pathology such as obstructive deviations of the nasal septum or polyposis and cranial nerve examination, including trigeminal stimulation, only confirmed the absence of olfaction.Subsequent imaging with the magnetic resonance scanner revealed a complete absence of the olfactory bulbs and nerves (see Figures 1–3and compare to the normal image in Figure 4). T2-weighted coronal sections through the anterior cranial fossa were performed. As demonstrated in the normal image (Figure 4), one can expect to see high signal in the olfactory sulcus along the base of the frontal lobe. This was entirely absent in this case, with no other significant pathology apparent. There is a high signal return in the right maxillary sinus of the subject, which is incidental and not related to smell perception. Also, Figure 4is in a patient with a cyst in the left maxillary sinus. Such incidental, asymptomatic 'sinusitis' on magnetic resonance scans is present in 30–40% of cases (Wani et al, 2001).Both the patient and her mother were counselled about the risks of environmental hazards. No further investigation was deemed necessary, or indeed desired by the patient.