Infected inferior turbinate pneumatization

With the widespread utilization of endoscopic nasal surgery, the interest in nasal structures has increased. Inferior turbinate pneumatization is among the most rare causes of nasal obstruction. In the current literature, there are only ten reported cases of inferior turbinate pneumatization. A 52-year-old male patient presented with nasal obstruction, purulent nasal discharge, facial pain and headache. Anterior rhinoscopic examination showed bilateral middle and inferior turbinate hypertrophy and edema of the nasal mucosa. Computed tomography (CT) revealed bilateral frontal, anterior and posterior ethmoidal and maxillary sinusitis with bilateral concha media bullosa and right infected inferior turbinate pneumatization. In this report, infection of this rare anatomical abnormality is presented for the first time and documented with acoustic rhinometry, CT and peroperative photography.     

Massive Concha Bullosa with Secondary Maxillary Sinusitis

Concha bullosa is a common anatomic variation of the middle turbinate; however, sinusitis secondary to the concha bullosa is rare. A 52-yr-old woman presented with nasal obstruction and posterior nasal drip. Computed tomography and examination of the nasal cavity revealed septal deviation on the left side, and a massive concha bullosa and maxillary sinusitis on the right side. The lateral lamella of the affected turbinate was removed and the inspissated material was drained. Histopathologic examination of the excised lesion in the concha bullosa revealed bacterial colonies in the mucus plug. We report here on a massive concha bullosa with secondary maxillary sinusitis.     

A massive superior concha bullosa: case report and literature review

The superior turbinate was the most neglected of the turbinates in the past. With the advent of functional endoscopic sinus surgery and coronal computed tomography imaging, considerable attention has been concentrated exclusively on the lateral nasal wall anatomy, including the hidden turbinate, whose symptomatic concha bullosa is extremely rare. Only a very few cases have been reported to date. This seemingly interesting as well as rare case report is concerned with unilateral hyperpneumatization of the superior turbinate, which contacts the septum and leads to headache, associated with bilateral massive concha bullosa of the middle turbinate.     

Concha bullosa of an inferior turbinate

Pneumatization of the inferior turbinate is a rare intranasal anatomic variant. In the English-language world literature, only 10 cases of inferior turbinate concha bullosa have been reported. We present the 11th such case, which we discovered during an evaluation of a patient who had chronic rhinosinusitis with allergic manifestations.     

A concha bullosa mucopyocele manifesting as migraine headaches: a case report and literature review

A concha bullosa is a common anatomic variant that represents an aerated turbinate, usually the middle turbinate. It is usually asymptomatic. When extensively pneumatized, a large concha bullosa may cause significant problems, including headache, nasal obstruction, and blockage of sinus drainage. We report a case of a large concha bullosa mucopyocele that manifested as recurring migraine headaches. It was successfully treated with surgical excision. We also review the available literature.     

泡性中鼻甲伴黏液囊肿1例报道并文献分析

目的 提高对泡性中鼻甲（CB）及中鼻甲黏液囊肿的认识和诊治水平。方法 报道1例CB伴黏液囊肿患者的临床资料并复习相关文献,随访患者术后恢复情况。结果 患者行鼻内镜下左侧CB外侧部分切除术,患者术后恢复好,鼻腔解剖结构清楚,鼻腔功能保留。结论 CB是一种常见鼻腔解剖变异,在患者出现相关症状就诊时发现或在健康体检中发现,其发展缓慢,症状多样,临床上容易漏诊、误诊。外科手术为其主要治疗方法,具体手术方式结合患者情况行个体化治疗。     

Large concha bullosa mucopyocele replacing the anterior ethmoid sinuses and contiguous with the frontal sinus

Concha bullosa, a pneumatized middle turbinate, is a common anatomic variant found in the paranasal sinuses. When a concha bullosa becomes obstructed, it can form a mucocele and, eventually, a mucopyocele if it becomes secondarily infected. This is a rare phenomenon; only 9 concha bullosa mucopyoceles have been previously reported in the English-language literature. We present the case of a large concha bullosa mucopyocele in a pediatric patient in which the concha bullosa replaced the anterior ethmoid sinuses and was contiguous with the frontal sinus.     

A unique case of multiple sites of pneumatization of the sinonasal bony framework in a pediatric patient

Anatomic variations of the sinonasal bony framework in the pediatric population are quite common. In children with such variations, however, bony pneumatization is uncommon. Moreover, pneumatization of the inferior turbinate in children is extremely rare; to the best of our knowledge, only 3 cases have been previously reported in the literature-none of which involved additional pneumatization variations of the sinonasal skeleton. Herein we present a new pediatric case that was unique in that an inferior concha bullosa coexisted with rarely seen pneumatized anatomic structures.     

Giant concha bullosa containing another concha bullosa inside: unique anatomic variation of the middle turbinate

Detailed knowledge of the anatomical variations of the lateral nasal wall is crucial for both the surgeon who is performing endoscopic sinus surgery and the radiologist who is involved in the preoperative work-up. Preoperative recognition of these variations will avoid possible complications during the surgery. In this report, we present a unique anatomical variant of the middle turbinate, a large concha bullosa inside a giant concha bullosa, which has never been reported before. Furthermore, we comment on the differential diagnosis of the variations of the middle turbinate and on the embryology of the nasal turbinates. This report also supplies additional aspects to rhinologists in the scope of middle turbinate pneumatization.     

Concha bullosa pyocele

An aerated middle turbinate is called a concha bullosa (CB), and given the importance of the middle turbinate in nasal physiology, variations that alter the airflow and mucous drainage can cause sinonasal symptoms. A pyocele of the middle turbinate differs from an infected CB because it has the potential to expand and destroy neighbouring tissues like a tumour. We present a concha bullosa pyocele (CBP) that expanded against the lamina papyracea without causing orbital displacement. As pus was discharged whilst performing an endoscopic biopsy to determine whether it was neoplastic, the lateral aspect of the turbinate was excised to complete the procedure.     

Concha bullosa. A radiological study and a new classification

ObjectiveA pneumatised middle turbinate is called concha bullosa. It has been classified according to its extension in the coronal plane. We propose the first classification according to the axial extension of pneumatisation of the middle turbinate.Material and methodsBulbous concha bullosa was classified in six categories according to the degree of pneumatisation of the body of the middle turbinate in the axial plane.Results196 CT sinonasal scans were included. 28.06% of patients had concha bullosa, unilateral in 13.26% and bilateral in 14.79%. The most common concha bullosa found was type I, followed by type III, II, IV and V. There were no statistically significant differences by side, between the patients with or without chronic rhinosinusitis without polyps.ConclusionOur results support the hypothesis that concha bullosa is not related to chronic rhinosinusitis. Furthermore, type IV and V cells mean posterior aeration of the middle turbinate. Those variations are rare and posterior, so they can easily pass unnoticed during endoscopic sinus surgery. Our classification is also important as a surgical reference, and it can be easily studied on the preoperative CT scan.     

Massive concha bullosa pyocele with orbital extention

Concha bullosa is the most common anatomic variant of the middle turbinate. It remains usually asymptomatic. Pyocele occurs when concha bullosa becomes infected. In the formation of a pyocele, middle turbinate may become expanded and occupy the surrounding structures with local bone destruction. Direct extension of mass from the nose into the orbit may occur, because the orbital contents are separated from the ethmoidal labyrinth only by the thin lamina papyracea. We report a case of concha bullosa pyocele with orbital extension. Orbital involvement is also associated with ocular functional loss. In this case, ocular motion and vision remained normal despite of the presence of orbital extension for 2 years.     

Assessment the long-term effects of septoplasty surgery on olfactory function

Objectives: This research aimed to evaluate pre-operatively and post-operatively the olfactory function of patients who had undergone surgery in our clinic for chronic nasal blockage via the Connecticut Chemosensory Clinical Research Center (CCCRC) smell test.

Method: Thirty-seven patients (24 females, 13 males) were enrolled in this study. All had undergone surgery in our clinic due to chronic nasal blockage (not for smell dysfunction), having been diagnosed with septal deviation in conjunction with concha bullosa and/or inferior turbinate hypertrophy. This is a prospective study without a control group. The mean age was 33.74?±?8.98 (range =19–54). All of the operations were performed under general anesthesia. CCCRC smell tests were performed on every patient before the operation and at post-operative 1st week, 6th week, 6th month, and 1st year.

Results: In this study, we found that septoplasty, in conjunction with middle concha surgery and/or inferior concha radiofrequency, did not affect the olfactory function negatively.

Conclusion: Although nasal surgery has the potential to affect the smell function negatively, it was found that olfactory function was not affected after the surgery during a considerably long follow-up period. Moreover, an improvement in smell function was detected at post-operative 6th month and 1st year.     

Concha bullosa: reducing middle meatal adhesions by preserving the lateral mucosa as a posterior pedicle flap

BACKGROUND: Concha bullosa, an extensively pneumatized middle turbinate, may obstruct the paranasal sinuses. Messerklinger's partial lateral turbinectomy is commonly used to debulk the concha bullosa, leaving a raw surface with the potential for adhesions. MATERIALS AND METHODS: A modified technique of partial lateral turbinectomy is described. A posterior pedicled mucosal flap covers the inferior raw surface of the medial lamella of the middle turbinate. Three-month follow up of a consecutive series is compared with concurrent controls. RESULTS: Two (7 per cent) of 28 posterior pedicled flap and four (21 per cent) of 19 traditional partial lateral turbinectomies developed mild middle meatal adhesions (p = 0.011). Posterior pedicled flap reduced the need for post-operative cleaning of the middle meatus. CONCLUSION: The posterior pedicled mucosal flap is a simple modification to partial lateral turbinectomy that covers the raw surface facing the lateral nasal wall, significantly reducing adhesions and speeding recovery.     

Trifurcate middle turbinate; an unusual anatomical variation

Anatomical variations of supernumerary middle turbinates include a secondary middle turbinate, which is a bony projection arising from the lateral nasal wall and covered by soft tissue, and an accessory middle turbinate, which is a medially bent uncinate process. Although pneumatization of the middle turbinate is common, inferior turbinate pneumatization is very rare. We report what we believe is the first case of a middle turbinate split into three divisions, i.e. trifurcated. This co-existed with a pneumatized inferior turbinate.     

Pneumatization of the concha inferior as a cause of nasal obstruction

Chronic nasal obstruction is a common disorder. Hypertrophy of the inferior turbinates is responsible for nasal obstruction more frequently than it is commonly thought. A pneumatized inferior turbinate has recently been described as a cause for nasal obstruction and only two cases have been reported until now. Inferior nasal turbinate develops by endochondral ossification of components of the mesethmoid and ectethmoid. The chondral framework of the inferior turbinate consists of a double lamella and two separate ossification centers that develop between the fifth and seventh month of fetal life. The separate ossification centers meet by the eighth fetal month. During ossification, the inferior turbinate detaches from the ectethmoid and becomes an independent bony structure. During that time the epithelium may misinvaginate into double lamellas and such double lamellas formed by the inferior turbinate may become persistent. A patient was referred to our clinic with headaches and nasal obstruction. A CT scan was performed which showed that the right lower concha was pneumatized. The headache of the patient disappeared after partial resection of the lower and middle turbinate.     

The relationship between the concha bullosa,nasal septal deviation and sinusitis

OBJECTIVES: To evaluate the possible relationship between concha bullosa, nasal septal deviation and sinusitis. PATIENTS AND METHODS: Paranasal sinus computed tomography scans of patients suffering from rhinosinusitis were examined. Fifty-four patients with concha bullosa were included in the study. The relationship between concha bullosa, nasal septal deviation and sinusitis was investigated. RESULTS: A statistically significant relationship between unilateral concha bullosa and nasal septal deviation was found (p < 0.01). The relationships of unilateral and bilateral concha bullosa with sinusitis, and bilateral concha bullosa with nasal septal deviation were not statistically significant (p > 0.05). CONCLUSION: In order to define the relation between the concha bullosa, nasal septal deviation and sinusitis, more detailed investigations are needed.     

Concha bullosa surgery and the distribution of human olfactory neuroepithelium

In bullous middle turbinate surgery, controversy exists over which side of the bullous middle turbinate should be removed, as the distribution of human olfactory neuroepithelium is unclear. This study evaluated whether the middle turbinate tissue of patients undergoing endoscopic concha bullosa surgery contains functional olfactory epithelium. This prospective clinical study was conducted in tertiary referable center. It detected 70 conchae bullosa in 48 patients with sinonasal symptoms, who underwent paranasal computed tomography (CT) that showed pneumatization of the middle concha. All samples were obtained under general anesthesia. Three samples were obtained from each bullous middle turbinate: one each from the anterior, medial, and lateral portions. The mucosa from each sample was stained with olfactory marker protein (OMP). In total, 210 middle turbinate samples were taken from 48 patients during endoscopic surgery for conchae bullosa. The patients were 22 females and 26 males. Of the 70 conchae bullosa, OMP-stained nerve tissue was found in the lateral, anterior and medial aspects of 57 (81.4 %), 42 (60.0 %) and 23 (32.8 %) of the bullous middle turbinates, respectively. OMP-stained nerve tissue was found in 122 (58.1 %) of the 210 bullous middle turbinate tissue samples. OMP-stained nerve tissue was found on the lateral surface of the bullous middle turbinate more often than the medial surface. Therefore, during the concha bullosa surgery, OMP-stained nerve tissue found at least in the medial part of concha, suggested that the opening of the medial part of middle concha.     

A new classification of septal deviations

STATEMENT OF PROBLEM: Existing nomenclatures of septal deviation deal with the deformation of the nasal septum exclusively and are rarely used in daily clinical work. The aim of this study was to develop a classification of septal deviations based upon the anatomical structures of the nasal septum and common clinical concepts. METHODS OF STUDY: We included patients undergoing septoplasty alone or in combination with rhinoplasty or functional endonasal sinus surgery by reason of septal deviation. Immediately after surgery, the surgeon recorded intraoperative findings of the nasal septum and the nasal turbinates in a data sheet and a standardized drawing for every patient. MAIN RESULTS: Data from 1088 patients were analyzed. Six types of septal deviations were identified. This new classification of septal deviations was developed with special regard to clinical anatomical findings. Leading as well as concomitant pathological findings were assigned to the six types of septal deviation. The frequencies of occurrence of hyperplasia of the inferior turbinate and concha bullosa of the middle turbinate were specified. PRINCIPAL CONCLUSION: The systematic assessment of relevant structures may help to develop improved surgical strategies. Furthermore, the systematic teaching of young surgeons to perform septal surgery may be facilitated.     

Bardet–Biedl syndrome and a large concha bullosa pyocele

Bardet–Biedl syndrome is a rare disease involving rode cone dystrophy, polydactyly, obesity, learning disabilities, hypogonadism and renal anomalies, symptoms caused by immotile cilia dysfunction. We report the first case of this syndrome in a teenager with an endonasal mass secondary to pyocele of a concha bullosa. The patient was treated successfully with endoscopic sinus surgery. Nasal obstruction secondary to a middle turbinate pyocele in Bardet–Biedl syndrome has not been described before. The pediatrician and the rhinologist should take this entity into consideration when investigating patients with Bardet–Biedl syndrome and sinonasal symptoms.