[Woodworker's nasal adenocarcinoma revealed by anosmia]. / Anosmie révélatrice d'un adénocarcinome nasal chez les travailleurs du bois.

OBJECTIVES: The aim of this article is to report two cases illustrating the origin of woodworkers' adenocarcinoma in the olfactory cleft and to discuss screening, prevention, and surgical approaches. MATERIAL AND METHOD: Retrospective study of the charts of two cases of adenocarcinoma of the olfactory cleft revealed by a loss of the sense of smell. RESULTS: Of 30 consecutive cases of woodworkers' adenocarcinoma of the olfactory cleft observed during the last 3 years, the two cases revealed by anosmia were diagnosed as small tumors located in one olfactory cleft. CONCLUSION: In light of these two cases, we discuss anosmia in the diagnostic screening of this tumor and its consequences in the olfactory cleft: flexible endoscopic examination of the olfactory cleft seems preferable to rigid endoscope examination of the middle meatus at screening; endoscopic resection of the olfactory cleft seems preferable to resection through external approaches; and nasal lavages seem preferable to the Proetz technique for preventive sinus lavage. The new knowledge on adenocarcinoma of the olfactory cleft should be familiar to occupational health physicians, general practitioners, and otorhinolaryngologists because of its practical consequences for screening, diagnosis, prevention, and surgical treatment.

Endoscopic surgery reveals that woodworkers' adenocarcinomas originate in the olfactory cleft.

The olfactory cleft is a narrow chamber located under the cribriform plate and between the turbinate wall of the ethmoidal labyrinth and the corresponding nasal septum. Nasal adenocarcinomas are mostly described as originating in the ethmoid sinus and operated via external approaches. We designed a prospective study on twenty consecutive woodworkers' adenocarcinomas without intracranial extension to determine the precise site of origin of the tumour. All patients were operated under endoscopic endonasal control according to a methodical surgical procedure as follows: 1) debulking of the tumour and identification of the middle turbinate or conchal lamina, 2) exenteration of the ethmoidal labyrinth according to the nasalisation procedure, and 3) exenteration of the olfactory cleft. Endoscopic endonasal surgery showed that woodworkers' adenocarcinomas constantly originated in the olfactory cleft, appearing as polyp-like neoplasms with well-defined bodies. Over a long period of time, they do not invade, but just displace and push out the surrounding structures, i.e. the nasal septum and the turbinate wall. More than the volume of the tumour, the precise location of the pedicle and especially its connection to the cribriform plate could be of major prognosis value.

CT assessment of woodworkers' nasal adenocarcinomas confirms the origin in the olfactory cleft.

BACKGROUND AND PURPOSE: Endoscopic endonasal surgery let us observe that woodworkers' nasal adenocarcinomas originate in the olfactory cleft. Our aim was the identification of CT imaging features that corroborate the olfactory cleft as the site of origin for woodworkers' adenocarcinoma. MATERIALS AND METHODS: We designed a retrospective study to compare CT scans of 27 unilateral olfactory cleft adenocarcinomas with 30 cases of nasosinusal polyposis (NSP) and 33 healthy sinus controls. Enlargement of the olfactory cleft, lateralization of the ethmoidal turbinate wall, and contralateral bulging of the nasal septum were measured on coronal scans passing through crista galli and posterior half of both ocular globes. Comparisons have been performed by using analysis of variance and the Bonferroni procedure. RESULTS: The nasal septum was significantly bulging across the midline in adenocarcinoma (4.6 +/- 3 mm; range, -0.1-13.7 mm) compared with NSP (0.7 +/- 1 mm; range, -2.1-2.3 mm) or healthy sinus controls (0.5 +/- 1 mm; range, -1.2-2 mm) (P < .001). The olfactory cleft was significantly wider in adenocarcinoma (15.1 +/- 4.5 mm; range, 8.6-25.7 mm) than in NSP (3.6 +/- 0.4 mm; range, 2.8-4.6 mm) or healthy sinus controls (3.3 +/- 0.7 mm; range, 1.4-4.6 mm). The ethmoidal labyrinth width was significantly smaller on the pathologic side in adenocarcinoma (7.2 +/- 2.7 mm; range, 3.2-14.2 mm) than in the control groups (P < .001). Whereas the angle between the conchal lamina and vertical midline was close to zero degrees in NSP (0.03 +/- 2.25 degrees ; range, -5 degrees -3 degrees ) and healthy sinus controls (0.45 +/- 2.13 degrees , range, -5 degrees -5 degrees ), it reached 39.76 +/- 13.83 degrees (P < .001) in adenocarcinoma. CONCLUSIONS: Radiologists should suspect nasal adenocarcinoma on sinus CT scans showing a unilateral expanding opacity of the olfactory cavity.