*5.2.1 Epidemiology*

The series includes 13 men and 2 women. The mean average is about 63 years old.

The majority of the patients are in the fifth and sixth decades.

**Figure 18.** *Illustration of a case with bilateral REAHs: pre- and postop imaging.*

*REAHs and REAH-Like Lesions: Underdiagnosed lesions Often Misconfused with Nasal Polyps DOI: http://dx.doi.org/10.5772/intechopen.90327*


**Table 2.**

Until now we have had no recurrence (**Figure 18**).

*MRI of a patient with bilateral REAHs: T1- and T2-weighted sequences.*

**REAH-like lesions**

*Sino-Nasal and Olfactory System Disorders*

common type.

**Figure 17.**

past 18 months.

*5.2.1 Epidemiology*

63 years old.

**Figure 18.**

**64**

**5.2 REAHs associated to a nasal polyposis often previously operated also called**

This is the second clinical pattern of REAHs, and certainly this is the most

The series includes 13 men and 2 women. The mean average is about

The majority of the patients are in the fifth and sixth decades.

*Illustration of a case with bilateral REAHs: pre- and postop imaging.*

**Table 2** reports a cohort of 16 patients diagnosed with such a pattern during the

*Cohort of patients with REAH-like lesions.*

All the patients suffer from a nasal polyposis. In two cases it was a massive primary polyposis. The other patients have a nasal polyposis operated in the past. The REAHs were diagnosed at the revision surgery.

Eight patients have concomitant asthma. Two patients have aspirin intolerance. Two patients have allergic rhinitis.

Chronic inflammation plays a role in the development of REAHs in this clinical pattern.

#### *5.2.2 Nasal endoscopy*

REAHs are located in the olfactory cleft. Their macroscopic aspect is different than usual nasal polyps extruding from the ethmoid sinus. They are more fleshy and firm. There is no necrosis.

As the following pictures show, it is extremely difficult to differentiate with the fibroscopy REAHs and inflammatory polyps in case of recurrent nasal polyposis. The histologic examination of the surgical specimens is mandatory for this differentiation (**Figure 19**).

#### *5.2.3 Imaging*

CT imaging findings are described in only a limited number of studies [1, 4, 5, 14]. Lima et al. [5], Hawley et al. [4], and Lee et al. (51 cases) [14] conclude that REAHs cause widening of the olfactory cleft more than 10 mm but generally do not cause bone erosion.

All the paranasal sinus cavities can be opaque as illustrated by the following pictures (**Figures 20–22**):

Some patients have a long-standing disease; REAHs develop after the surgery with time. Some of them are attached to the anterior and superior portion of the

#### **Figure 19.**

*Comparison of the nasal endoscopy and the histological pattern. The inflammation in the stroma is much more important than in pure REAHs.*

#### **Figure 20.**

*CT showing a severe nasal polyposis; widening of the olfactory cleft raises suspicion of REAHs.*

nasal septum and cause blockage of the frontal sinus pathway or even thinning

*Same patient with thinning and erosion of the nasal bones (arrows) and opacity of both frontal sinuses.*

MRI can be of some help to rule out other lesions such as encephalocele,

The management of REAHs associated with nasal polyposis must be discussed

and erosion of the nasal bones.

case by case.

**67**

**Figure 23.**

**Figure 22.**

olfactory neuroblastoma, or glioma.

**Figure 23** show such an exceptional evolution.

*Typical CT scan showing the opacity of both olfactory clefts caused by REAHs.*

*DOI: http://dx.doi.org/10.5772/intechopen.90327*

*REAHs and REAH-Like Lesions: Underdiagnosed lesions Often Misconfused with Nasal Polyps*

#### **Figure 21.**

*Patient with REAHs in the olfactory cleft. She had a standard ethmoidectomy for nasal polyposis. We observe REAHs in the olfactory cleft. Correlation between CT scan and nasal endoscopy.*

*REAHs and REAH-Like Lesions: Underdiagnosed lesions Often Misconfused with Nasal Polyps DOI: http://dx.doi.org/10.5772/intechopen.90327*

**Figure 22.** *Typical CT scan showing the opacity of both olfactory clefts caused by REAHs.*

**Figure 23.** *Same patient with thinning and erosion of the nasal bones (arrows) and opacity of both frontal sinuses.*

nasal septum and cause blockage of the frontal sinus pathway or even thinning and erosion of the nasal bones.

**Figure 23** show such an exceptional evolution.

MRI can be of some help to rule out other lesions such as encephalocele, olfactory neuroblastoma, or glioma.

The management of REAHs associated with nasal polyposis must be discussed case by case.

**Figure 19.**

**Figure 20.**

**Figure 21.**

**66**

*important than in pure REAHs.*

*Sino-Nasal and Olfactory System Disorders*

*Comparison of the nasal endoscopy and the histological pattern. The inflammation in the stroma is much more*

*CT showing a severe nasal polyposis; widening of the olfactory cleft raises suspicion of REAHs.*

*Patient with REAHs in the olfactory cleft. She had a standard ethmoidectomy for nasal polyposis. We observe*

*REAHs in the olfactory cleft. Correlation between CT scan and nasal endoscopy.*

A complete sphenoethmoidectomy is usually necessary to manage the recurrent nasal polyposis.

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For the REAHs, debulking or better exenteration of the olfactory cleft must be considered. But we know that it can be tricky and risky for the skull base with a risk of CSF leak if the surgery is too aggressive. Resection of the REAHs is usually more bloody than during a polypectomy.

In the case of frontal opacity caused by REAHs attached to the anterior and superior septa, a Draf III procedure must be considered.

After surgery medical treatment of the nasal polyposis and asthma remains absolutely necessary to prevent or delay as much as possible recurrences.
