Management of nasal polyposis arising from the olfactory cleft.

OBJECTIVES Although nasal polypi frequently arise from the middle meatus, they may occasionally originate from the olfactory cleft. Removal of these polypi may be difficult because of obscure location and concomitant occurrence of septal deviation. This work describes surgical management of olfactory cleft nasal polypi with a combined approach involving septoplasty and endoscopic sinus surgery. PATIENTS AND METHODS The study included 12 patients (4 females, 8 males; mean age 30.4; range 17 to 58 years) who were treated for nasal polypi arising from the olfactory cleft. Polypi were unilateral in four patients and bilateral in eight patients. Endoscopic removal of the nasal polypi required an initial septoplasty to allow visualization of the olfactory cleft and to straighten the nasal septum. The follow-up period ranged from three to six months. RESULTS Visualization of the olfactory cleft was accomplished without complications. This allowed radical removal of nasal polypi in all the patients with relief of initial symptoms. Total relief of nasal obstruction was achieved in eight patients. Four patients who had sagging nasal mucosa and bilateral nasal polyposis had moderate relief. CONCLUSIONS Nasal polyposis arising from the olfactory cleft can be effectively removed by nasal endoscopy following an initial septoplasty to widen the narrow area at the olfactory cleft for better visualization and manipulation.