The olfactory cleft is the narrow air-filled space in the superior nasal cavity between the superior nasal septum medially and the superior nasal turbinate laterally, leading to the olfactory neuroepithelium in the most superior aspect. The olfactory neuroepithelium (yellow-brown, containing bipolar sensory neurons) lines approximately 5 cm of the superior nasal vault within and above this cleft, with olfactory nerve filaments passing through the cribriform plate to the olfactory bulb.
The olfactory cleft is the endoscopic target for assessment of olfactory neuroepithelium integrity in anosmia evaluation. Post-viral anosmia (as seen after COVID-19) involves inflammatory damage to the olfactory epithelium and cleft; OCT imaging of the olfactory cleft can demonstrate mucosal changes. Endoscopic skull base approaches transect the olfactory cleft during olfactory groove meningioma and anterior skull base resection. Sinonasal polyps extending into the olfactory cleft displace the olfactory epithelium and cause hyposmia. Preserving the olfactory cleft in FESS is critical to maintaining smell function.
SARS-CoV-2 infection causes inflammation of the sustentacular cells in the olfactory cleft that support olfactory neurons, producing anosmia or hyposmia; olfactory cleft imaging on MRI CISS sequences demonstrates mucosal swelling and loss of the normal olfactory epithelium signal, with olfactory training involving repeated smell exposure to specific scents aiding recovery in most patients within 12 months.
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