xRead - Nasal Obstruction (September 2024) Full Articles

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in three studies. 587,592,593 Subjectively, 86%–91% patients experience improvement in olfaction postoperatively 587,593 Using the Sniffin’ Sticks test, 45% of patients with preoper ative hyposmia had improved olfactory function. 592 Inthis study, poor olfactory outcomes were significantly associ ated with previous surgery and previous middle turbinate resection. 2 Chondro-osseous respiratory epithelial adenomatoid hamartoma COREAH is an exceedingly rare type of sinonasal hamar toma, with fewer than 20 cases reported to date in the most recent LR. 595 COREAH has the same epithelial com ponents as REAH, with the addition of mesenchymal elements including cartilaginous and/or osseous trabecu lae. Nearly all reported cases have been located in the nasal cavity, with sites of origin including the lateral nasal wall, posterior septum, olfactory cleft, and middle turbinate. Cases have been reported from ages 3 to 83 years, with out a clear sex predilection. 595 In contrast to REAH, there are no cases of COREAH occurring with comorbid nasal polyposis. On CT imaging, 58% lesions have intralesional bony density/calcification, and none show adjacent bone ero sion. On MRI, COREAH appears as a heterogeneously T2-isointense/hyperintense expansile mass that may have cystic components. 595 All reported cases have been treated with surgical excision, with one case reporting recurrence at 1 year. 595 3 Nasal chondromesenchymal hamartoma NCH is very rare, with about 50 reported cases to date. While traditionally categorized as a sinonasal hamartoma, NCH is now understood to be a benign neoplasm with strong association with DICER1 syndrome. NCH is pre dominantly found in children, with a median age of 9.6 years (range 1 day to 69 years) and about one third of reported cases found in patients younger than 1 year. 596 NCH most commonly presents with nasal obstruction, which in the nasally dependent newborn can lead to stertor or respiratory distress. Other presenting features include eye abnormalities, facial swelling, headache, sinusitis, and epistaxis. Tumor locations have been most commonly reported in the ethmoid cavity (24%), followed by the orbit (19%), skull base/intracranial (20%), maxillary sinus (14%), and nasal cavity (8%). 597 NCH has been associated with the DICER1 famil ial tumor predisposition syndrome, characterized by germline pathogenic loss-of-function mutation in DICER1 ,

a gene that encodes for a multifunctional protein with RNA endonuclease activity implicated in microRNA production. 597 Patients with DICER1 syndrome have increased risk of multiple benign and malignant tumors in addition to NCH, including pleuropulmonary blastoma, ovarian sex cord-stromal tumors, thyroid hyperplasia and neoplasia, and pituitary blastoma, among others. 598 Asys tematic review found that 38% of patients with NCH had at least one other DICER1 -associated tumor. 597 As such, a diagnosis of NCH should prompt consideration of DICER1 genetic testing and comprehensive oncologic surveillance. On histology, NCH demonstrates predominantly carti laginous nodules, ranging in differentiation from imma ture chondromyxoid matrix to mature cartilage. An osseous component may also be present, ranging in differ entiation from immature woven bone to mature ossicles. 571 Generally, no significant mitotic activity or necrosis is expected. Radiographically, NCH demonstrates areas of matrix calcification on CT; on MRI, the mass is generally T2 hyperintense secondary to high water content within the extracellular matrix of hyaline cartilage, while areas of mineralization appear lower in signal intensity. 599 All reported cases of NCH underwent surgical resec tion, with the approach dependent on tumor location and size. Both endoscopic and open approaches have been employed in NCH. Among all reported cases, 24 patients have follow-up reported (mean 24 months). Of these cases, 45.8% reported persistent or recurrent disease, often requir ing surgical re-resection. 596 There is one reported case of malignant transformation at 3 months follow-up, in a 40-year-old female. 600 B Nasolabial cysts Nasolabial cysts (NLCs) are benign, nonodontogenic cysts arising in the anterior maxillary region, often located submucosally in the anterior nasal floor. The etiology of NLCs is thought to be a result of a developmental error from the epithelial rests at the fusion of globular, lateral, nasal, and maxillary processes from embryonic remnants of the nasolacrimal duct. 601 NLCs are found across all ages (range 4 months to 78 years), with a roughly 3:1 female predilection in reported cases. 602 The most common presenting symptom is facial swelling in the nasolabial region (71%), followed by nasal obstruction (17%). Rarely, NLCs present as an acutely infected cyst (3%). 602 Examination can demonstrate a variably fluctu ant or tender mobile cyst within the nasolabial area, and endoscopy can demonstrate submucosal fullness in the anterior nasal floor. 603 CT of NLC demonstrates a well-defined, low-density cyst in the nasolabial region. 601,602,604,605 Erosion or