Serum SCC in the Diagnostic Algorithm of Inverted Papilloma

Abstract

OBJECTIVE: The primary cause of rhinogenic pain is sufficient contact between bones, which triggers nocioceptive fibers within the trigeminal nerve. A concha bullosum becomes symptomatic if pain receptors are susceptible when bony contact occurs. A distinct, rarer manifestation of a concha bullosum is barometric pain. Sinus barotrauma can be limited to the middle turbinate. We present a patient who had both rhinogenic and barometric pain. METHOD: A 41 year-old male complained of two years of severe, episodic left mid-facial pain. He was initially diagnosed as having trigeminal neuralgia, but failed medical therapy. A second otolaryngologist considered a dental etiology, but his pain persisted despite root canal surgery. A CT scan revealed a concha bullosum involving the left middle turbinate. Bone expansion resulted in septal contact. His primary pain was cyclical, coinciding with four-hour nasal cycle intervals. On further inquiry, he described a second source of pain, coincidentally with the same onset. He was a propeller plane pilot. At higher elevations he was asymptomatic. During descent he developed identical left mid-facial pain which took up to two hours to resolve. A single sky-diving experience exacerbated the symptom. RESULTS: As a pilot, his pharmaceutical options were limited. OTC analgesics provided minimal relief. He underwent excision of the concha bullosum. Post-operatively the pain attributable to the nasal cycle resolved. Changes in altitude and barometric pressure no longer caused pain. CONCLUSION: Concha bullosae can be the source of two distinct types of facial pain, rhinogenic and barometric. Partial resection of the offending middle turbinate may relieve both conditions.