Endoscopic endonasal resection of respiratory epithelial adenomatoid hamartomas of the sinonasal tract

Abstract

REAH is a benign well-defined pathological entity but is still unfamiliar. REAH should be kept in mind as a differential diagnosis from more aggressive lesions to avoid unnecessary surgical procedure. A complete but conservative endoscopic resection appears to be curative.

Bilateral Respiratory Epithelial Adenomatoid Hamartomas Originating from the Anterior Olfactory Clefts

“…Appropriate caution should be taken when considering the diff erential of olfactory cleft masses to minimize surgical risks to patients. While there is insuffi cient evidence tracking the recurrence of REAH, available data have shown no benefi t in preventing recurrence with more aggressive removal, including subperiosteal dissection (8). Standard endoscopic resection without subperiosteal involvement was performed to remove REAH from our patient, and there has been no evidence of recurrence on endoscopy in a 14-month postoperative period or by MRI in a 27-month period.…”

“…One of the most common presenting symptoms of REAH is hyposmia or anosmia (8). Th is is likely caused by local impingement or loss of olfactory nerves within the aff ected olfactory clefts.…”

“…In one retrospective study of REAH surgical subjects, no diff erence was noted in outcomes between standard endoscopic sinus surgery and aggressive resection with subperiosteal dissection and drilling into the adjacent bone (8). Along with a computed tomography scan and MRI with contrast medium to evaluate the site and the extent and features of the lesion(s), some have recommended a preoperative biopsy in cases of a unilateral lesion or widening of the olfactory cleft (1-3, 8, 15).…”

“…Most reports indicate that REAH occurs in the presence of sinonasal infl ammation (1-3, 5, 6). Presenting signs and symptoms include nasal obstruction, nasal congestion, deviated septum, epistaxis, rhinorrhea, chronic sinusitis, facial pain, headache, and olfactory dysfunction (7,8). Complete surgical resection is the preferred treatment (8).…”

Role of endoscopic surgery in the management of sinonasal and skull base schwannomas

“…However, these procedures have unavoidable disadvantages, such as high postoperative morbidity caused by aesthetic disfigurations, transient or permanent sensitive loss, and lengthy duration in terms of anesthesia and postoperative hospitalization. Over the past few years, the endoscopic endonasal technique became a safe and effective alternative for the treatment of selected sinonasal schwannomas as for other benign sinonasal tumors …”