Dysgenesis of the middle turbinate: A unique cause of nasal airway obstruction

Abstract

Abstract : We present a unique case of nasal airway obstruction resulting from dysgenesis of the middle turbinate that has not been previously described. A 33-year-old woman presented to our clinic with a long history of right nasal airway obstruction refractory to medical management with nasal steroid sprays and antihistamines. She denied both epistaxis and rhinodynia, and had no history of nasal surgery. Additionally, she had never been nasally intubated for any other surgical procedure and had no history of nasal manipulation or trauma to the face. Nasopharyngoscopy demonstrated the absence of a normal middle turbinate (MT) and an obstructing mass in the posterior right nasal cavity that completely occluded the right choana (Fig 1). A computed tomography (CT) scan of the paranasal sinuses revealed a pedunculated nasal mass occurring at the posterior attachment of the malformed right MT (Fig 2). Clinical biopsy specimens were conclusive for benign respiratory mucosa, and the patient consented to operative removal of the mass. Intraoperatively, the mass was transected at the pedicle and easily delivered through the nasopharynx into the oral cavity for removal. The mass was sectioned and noted to have a firm bony rim, with a fluid-containing mucocele in the center. The patient had complete resolution of her symptoms postoperatively, and three months later she remained asymptomatic and without recurrence. This case report has been approved by the Institutional Review Board of Wilford Hall Medical Center (FWH20080139N). Patient consent for publication has been obtained by the authors.