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Abstract Objectives: To highlight the prevalence of respiratory epithelial adenomatoid hamartomas in the olfactory cleft of patients with nasal polyposis. To demonstrate characteristics indicative of hamartoma on the CT scans of paranasal sinuses during surgery and in histopathological exams. Methods: Cross-sectional study carried out in Hospital das Clínicas da UFMG and Núcleo de Otorrino BH. We performed 114 nasal endoscopic surgeries for polyposis, between February 2015 and November 2019. We assessed the olfactory cleft width in all preoperative CT scans. Upon seeing an indication of hamartoma on the CT scan, we took a tissue sample from the olfactory cleft during the surgery and sent for histopathological exam. We referred the samples to a pathologist experienced in the anatomopathological diagnosis of respiratory epithelial adenomatoid hamartomas. Results: Of the 114 patients with polyposis, 54 (47.4%) had olfactory cleft enlargement and, 100% of them had tissue with a dense and hardened polypoid aspect, with a slight cerebri-form appearance in this region during the surgery. Histology confirmed a respiratory epithelial adenomatoid hamartoma. Conclusion: This observation suggests that the presence of hamartomas in polyposis is common, but underdiagnosed. Level of evidence: Step 3 (Level 3).
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Objective To establish a method for recognizing nasal bleeding sites and hemorrhagic foci of hidden epistaxis.Methods The bleeding sites and hemorrhagic foci,as well as the used surgical techniques and the curative effects were studied retrospectively in 122 patients with spistaxis from Jan.2005 to Oct.2007,in whom the bleeding sites and hemorrhagic foci were not found by routine nasoscope examination.Under nasal endoscopic monitoring,electric heat cauterization(EHC),microwave coagulation(MC) and micro-traumatic nasal packing(MTNP) were applied respectively to treat the hidden epistaxis.Results The hemorrhagic foci were found in the following sites:Olfactory cleft 48 cases(39.3%),superior wall of inferior nasal meatus 20 cases(16.4%),posteroinferior wall of middle nasal meatus 6 cases(4.9%) and so on.Epistaxis was well controlled in 113 of 122 cases(92.6%),in whom the hemorrhagic foci were found by endoscope,by laser soldering,MC and EHC.Packing with mini gel foam was used in 9 cases,for whom the hemorrhagic foci were not found.No complications occurred during a 1-2 months of follow up after treatment.Of the 122 cases,106 cases(86.9%) stopped bleeding by treatment once and 16 cases(13.1%) stopped by treatment twice.Conclusion The lateral or posterior area of middle and inferior nasal meatus,and olfactory cleft area are the frequent sites of hidden epistaxis.Examination with endoscopy,combined with the findings on the middle and inferior turbinate and the features of blood flow in different sites,will be important on recognizing the hidden epistaxis and locating the hemorrhagic foci.