Two cases of concha bullosa in a contemporary Cypriot skeletal collection

The nasal turbinates are important structures in the nasal cavity. Pneumatization of the turbinates, also known as concha bullosa, is a common anatomical variant of the nasal cavity. Concha bullosa usually arises from the middle turbinates and rarely in the superior and inferior turbinates. Pneumatization of the uncinate process, also known as an uncinate bulla, is very rare and most cases are asymptomatic, although it may cause nasal obstruction in some cases. Quadruple concha bullosa refers to case of triple concha bullosa (superior, middle, and inferior concha turbinates concha bullosa) accompanied by an uncinate bulla, although this has never been reported. Here, we report a case of quadruple concha bullosa and discuss it along with a review of the literature. (J Clinical Otolaryngol 2017;28:252-255)

Background: Middle nasal concha hypertrophy known as concha bullosa is caused by its pneumatization. Although it is the most common anatomical variation of the ostiomeatal complex, research on it in different populations is limited. It is uncertain whether concha bullosa prevalence varies across populations throughout the world.
 Objective: The purpose of study was to determine the prevalence of (superior, middle and inferior turbinate concha bullosa) in patients who visited an ENT clinic with various ENT symptoms.
 Methods: The duration of this retrospective descriptive study was six month. The study was carried out between the period from June 2022 to November 2022 at Department of ENT and Head & Neck Surgery. We examined the axial and coronal planes of patients' computed tomography (CT) scans of nose as well as paranasal sinuses who reported headaches or nasal obstruction symptoms in addition to symptoms of chronic sinusitis.
 Results: Concha bullosa was seen in 14% of the 100 scans examined. Six (42.8%) individuals had bilateral concha bullosa, whereas eight (57.1%) had unilateral concha bullosa. Out of the eight conchae, two (25%) were found on the right side while six (75%) on the left side.
 Conclusion: Study concluded that concha bullosa is the most common anatomic variation. During the preoperative evaluation, the radiologist must pay close attention to anatomical variants. It is critical for surgeons to be aware of this variation.

Введение. В настоящее время остается актуальным поиск достоверных факторов риска развития хронического синусита и его обострений у детей разных возрастных групп. Такие факторы, как смещение перегородки носа, увеличенные нижние и средние носовые раковины, нарушения в структуре остиомеатального комплекса, гипертрофия аденоидов, новообразования полости носа и околоносовых пазух и другие, играют роль в возникновении синусита, но на данный момент недостаточно изучены у детей. В последние два десятилетия отмечается тенденция к увеличению числа случаев рецидивирующих и хронических форм синусита у пациентов детского возраста. Проблема также обусловлена нередким стремительным переходом в пансинусит, изменением аэродинамики, что ведет к развитию дисфункции внутренних органов и систем и, как следствие, снижению качества жизни. Определение роли анатомофункциональных особенностей полости носа и околоносовых пазух в патогенезе хронического синусита у детей является важным и целесообразным в отношении вторичной медицинской профилактики. Цель. Выявить функциональные и анатомические особенности полости носа и установить факторы риска развития хронического, острого рецидивирующего синусита у детей с гипертрофией аденоидов 1–3-й степени. Материалы и методы. Ретроспективно проведен анализ 54 амбулаторных и стационарных карт пациентов, содержащих данные анамнеза, фарингоскопии, отоскопии, эндоскопического исследования, передней активной риноманометрии и функции мерцательного эпителия (мукоцилиарного клиренса) пациентов детского возраста с хроническим синуситом, острым рецидивирующим синуситом и гипертрофией аденоидов 1–3-й степени, которые находятся на лечении в Республиканском научно-практическом центре оториноларингологии с 2015 г. по настоящее время. Средний возраст (медиана) пациентов составил 9,7 года (Me=10), среди пациентов были 33 мальчика (61%) и 21 девочка (39%). Пациенты с хроническим синуситом и острым рецидивирующим синуситом составили основную исследуемую группу, пациенты с гипертрофией аденоидов 1–3-й степени – группу сравнения. У всех пациентов выполнен сбор жалоб и анамнеза; проведена фарингоскопия, отоскопия, эндоскопическое исследование полости носа и носоглотки, передняя активная риноманометрия, определение транспортной функции мерцательного эпителия полости носа (мукоцилиарный клиренс). Статистическая обработка данных осуществлялась с использованием пакета прикладных программ Statisticа 10 (StatSoft, Inc., США, лицензия № AXXR012E839529FA). Результаты. Среди анатомических особенностей выявлены: смещение перегородки носа, изменения в структуре носовых раковин (гипертрофия нижних носовых раковин, Concha Bullosa одно- или двусторонняя), нарушения в строении остиомеатального комплекса, обтурация носовых ходов полипами. По данным эндоскопического исследования в основной группе у 20 пациентов (77%) выявлена 1-я степень гипертрофии аденоидов, у 6 пациентов (23%) – 2–3-я степень. В группе сравнения у 5 пациентов (18%) выявлена гипертрофия аденоидов 1-й степени, у 23 пациентов (82%) – 2–3-й степени. По данным передней активной риноманометрии установлена слабая степень обструкции у 9 (35%) пациентов основной группы, что статистически значимо больше, чем в группе сравнения – у 3 (14%) пациентов (p<0,05). По умеренной степени обструкции не выявлено значимых различий у пациентов исследуемых групп (p>0,05): 9 (35%) пациентов основной группы и 8 (38%) пациентов группы сравнения. Выраженная степень обструкции выявлена у 6 (23%) пациентов основной группы, что статистически значимо меньше, чем в группе сравнения – 9 (43%) пациентов (p<0,05). Время сахаринового теста у пациентов основной группы статистически значимо увеличено при первичном осмотре и выписке, чем у пациентов группы сравнения. Выводы. В результате проведенного исследования установлены функциональные и анатомические особенности полости носа у детей с хроническим синуситом, острым рецидивирующим синуситом и гипертрофией аденоидов 1–3-й степени. По данным эндоскопического исследования полости носа гипертрофия аденоидов 1-й степени выявлена у 77% пациентов основной группы (n=20), что статистически значимо больше, чем в группе сравнения – у 18% пациентов (n=5; p<0,05). В группе сравнения преобладали пациенты с гипертрофией аденоидов 2–3-й степени – 82% (n=23), что статистически значимо больше, чем в основной группе (p<0,05). Ведущей причиной обструкции у пациентов основной группы являлись отек полости носа – 92% (n=24) и такие анатомические особенности полости носа и околоносовых пазух, как смещенная носовая перегородка – 85% (n=22), гипертрофия нижних носовых раковин, Concha Bullosa – 81% (n=21), особенности строения латеральной стенки полости носа (вогнутость, наличие дополнительного соустья, гипертрофия крючковидного отростка) – 50% (n=13), обтурация носовых ходов полипами – 46% (n=12). У пациентов группы сравнения основной причиной назальной обструкции была полная или частичная блокада хоан гипертрофированной глоточной миндалиной – 100% (n=28), что проявлялось умеренной и выраженной степенью обструкции. Также у пациентов группы сравнения были выявлены такие анатомические особенности полости носа, как смещенная носовая перегородка – 25% (n=7), гипертрофия нижних носовых раковин, Concha Bullosa – 32% (n=9). По данным передней активной риноманометрии установлено, что у пациентов основной группы преобладала слабая и умеренная степень обструкции, у пациентов группы сравнения – умеренная и выраженная. Время сахаринового теста у пациентов основной группы статистически значимо больше, чем у пациентов группы сравнения (p<0,05), что обусловлено длительным угнетением двигательной активности мерцательного эпителия полости носа и околоносовых пазух. Таким образом, гипертрофия аденоидов 1–3-й степени, смещение носовой перегородки, гипертрофия нижних и средних носовых раковин, особенности строения латеральной стенки полости носа, обтурация носовых ходов полипами, назальная обструкция и удлинение времени сахаринового теста могут рассматриваться как факторы риска хронического и рецидивирующего синусита у детей с гипертрофией аденоидов 1–3-й степени. Introduction. Currently, the search for reliable risk factors for the development of chronic sinusitis and its exacerbations in children of different age groups remains relevant. Factors such as displacement of the nasal septum, enlarged inferior and middle turbinates, disturbances in the structure of the osteomeatal complex, hypertrophy of the adenoids, neoplasms of the nasal cavity and paranasal sinuses, and others play a role in the occurrence of sinusitis, but are currently not well understood in children. In the last two decades, there has been a trend towards an increase in the number of cases of recurrent and chronic forms of sinusitis in pediatric patients. The problem is also caused by the frequent rapid transition to pansinusitis, changes in aerodynamics, which leads to the development of dysfunction of internal organs and systems, and, as a result, a decrease in the quality of life. Determining the role of the anatomical and functional features of the nasal cavity and paranasal sinuses in the pathogenesis of chronic sinusitis in children is important and appropriate in relation to the secondary medical prevention of chronic sinusitis in children. Purpose. To identify the functional and anatomical features of the nasal cavity and to establish risk factors for the development of chronic, acute recurrent (not only, and so on) sinusitis in children with adenoid hypertrophy of 1–3 degrees. Materials and methods. A retrospective analysis was made of 54 outpatient and inpatient charts of patients containing data on anamnesis, pharyngoscopy, otoscopy, endoscopic examination, anterior active rhinomanometry and the function of the ciliated epithelium (mucociliary clearance) of pediatric patients with chronic sinusitis, acute recurrent sinusitis and adenoid hypertrophy of 1–3 degrees, who were treated at the Republican Scientific and Practical Center of Otorhinolaryngology from 2015 to the present. The mean age (median) of the patients was 9,7 (Me = 10) years, among the patients there were 33 boys (61%) and 21 girls (39%). Patients with chronic sinusitis and acute recurrent sinusitis made up the main study group, patients with grade 1–3 adenoid hypertrophy made up the comparison group. All patients collected complaints and anamnesis; pharyngoscopy, otoscopy, endoscopic examination of the nasal cavity and nasopharynx, anterior active rhinomanometry, determination of the transport function of the ciliated epithelium of the nasal cavity (mucociliary clearance) were performed. Statistical data processing was carried out using the Statistica 10 software package (StatSoft, Inc., USA, license No. AXXR012E839529FA). Results. Among the anatomical features, a displacement of the nasal septum, changes in the structure of the turbinates (hypertrophy of the inferior turbinates, Concha Bullosa unilateral or bilateral), disturbances in the structure of the ostiomeatal complex, neoplasms of the nasal cavity and paranasal sinuses were revealed. According to the endoscopic examination in the main group, 20 patients (77%) had grade 1 adenoid hypertrophy, 6 patients (23%) had grade 2–3. In the comparison group, 5 patients (18%) had grade 1 adenoid hypertrophy, and 23 patients (82%) had grade 2–3. According to the data of the anterior active rhinomanometry, it was found that a mild degree of obstruction was detected in 9 (35%) patients of the main group, which is significantly more than in the comparison group – 3 (14%) patients (p<0.05); there were no significant differences in the moderate degree of obstruction in patients of the studied groups (p>0.05): 9 (35%) patients of the main group and 8 (38%) patients of the comparison group; a pronounced degree of obstruction was detected in 6 (23%) patients of the main group, which is significantly less than in the comparison group – 9 (43%) patients (p<0.05). The time of the saccharin test in patients of the main group was statistically significantly increased at the initial examination and discharge than in patients of the comparison group. Conclusions. As a result of the study, the functional and anatomical features of the nasal cavity in children with chronic sinusitis, acute recurrent sinusitis and adenoid hypertrophy of 1–3 degrees were established. According to the endoscopic examination of the nasal cavity, grade 1 adenoid hypertrophy was detected in 77% of patients of the main group (n=20), which is statistically significantly more than in the comparison group – 18% of patients (n=5; p<0.05). The comparison group was dominated by patients with grade 2–3 adenoid hypertrophy – 82% (n=23), which is statistically significantly more than in the main group (p<0.05). The leading cause of obstruction in patients of the main group was swelling of the nasal cavity – 92% (n=24) and such anatomical features of the nasal cavity and paranasal sinuses as a displaced nasal septum – 85% (n=22), hypertrophy of the inferior turbinates, Concha Bullosa – 81% (n=21), structural features of the lateral wall of the nasal cavity (concavity, the presence of an additional anastomosis, hypertrophy of the uncinate process) – 50% (n=13), obstruction of the nasal passages with polyps – 46% (n=12). In patients of the comparison group, the main cause of nasal obstruction was a complete or partial blockade of the choanae of the hypertrophied pharyngeal tonsil – 100% (n=28), which was manifested by a moderate and severe degree of obstruction. Also, in patients of the comparison group, such anatomical features of the nasal cavity as a displaced nasal septum – 25% (n=7), hypertrophy of the inferior turbinates, Concha Bullosa – 32% (n=9) were identified.

Common anatomic variants of the middle nasal turbinate include its pneumatization (i.e. concha bullosa media) and its paradoxical curvature. We report here two cases of differently combined variations of the middle turbinate which were documented in cone beam computed tomography (CBCT). The first report presents the vertical combination of a double or septated lamellar concha bullosa with the paradoxical curvature of middle turbinate. This combined variant associated (coincidental findings): ipsilateral paradoxical superior turbinate and contralateral paradoxical middle turbinate, concha bullosa superior and concha bullosa suprema. In the second case was found the sagittal combination of successive anterior concha bullosa media and posterior paradoxical curvature of the middle turbinate. An ethmoidal sinolith was found embedded in lamella basalis. The contralateral superior turbinate was pneumatized. These rare findings demonstrate that sound knowledge of possible anatomical variations, supported by a complete use of the tools available for the CBCT documentation of cases, is able to enrich the picture of human anatomic variations, with a direct impact on clinical and surgical practice. The septa-containing lamellar concha bullosa and paradoxical middle concha combination is a variation that affects surgical practice.

Background: Concha bullosa (CB), pneumatization of a nasal turbinate, is a common anatomical variation, most frequently affecting the middle turbinate. Its role in the pathogenesis of maxillary sinusitis (MS) remains debated, with particular interest in the impact of CB size. Computed Tomography (CT) is the gold standard for evaluating sinonasal anatomy. Objective: This study aimed to investigate the incidence of concha bullosa in middle turbinate and its relationship to maxillary sinusitis in a cohort of 150 patients using CT imaging, with a focus on demographic factors and the significance of large concha bullosa. Methods: A retrospective analysis of paranasal sinus CT scans from 150 adult patients (age 18-65 years) was conducted. Data on age, gender, presence and type of CB (classified as small/medium or large, with large CB defined as occupying >50% of the middle meatus height), and presence of MS were collected. Statistical analysis, including chi-squared tests, was performed to assess associations, with p < 0.05 considered significant. Results: The mean age of the 150 patients was 41.02 ± 13.52 years, with 78 (52.00%) females and 72 (48.00%) males. Concha bullosa was present in 87 patients (58.00%). Maxillary sinusitis was identified in 48 patients (32.00%). No statistically significant association was found between the overall presence of concha bullosa and maxillary sinusitis (p = 0.5561). However, a highly significant association was observed between large concha bullosa and maxillary sinusitis (p < 0.0001), with 69.23% of patients with large CB also having MS. Conclusion: Concha bullosa is a frequent anatomical variant, found in 58.00% of this cohort. Its overall presence did not show a statistically significant correlation with maxillary sinusitis in this study. However, large concha bullosa was strongly associated with an increased incidence of maxillary sinusitis, suggesting that the size of the concha bullosa is a critical factor in its potential to contribute to sinus pathology. These findings underscore the importance of detailed CT evaluation, particularly of CB size, in patients with sino-nasal symptoms.

BACKGROUND. Pneumatization of the turbinate is also known as concha bullosa (CB). Concha bullosa is most commonly found in the middle turbinate; its occurrence in the inferior turbinate is very rare. MATERIAL AND METHODS. A search of the literature was conducted using PubMed, Medline, Google and Google Scholar search engines using the keywords “inferior turbinate and concha bullosa”, “inferior turbinate and pneumatization”, covering the period from 1990 to 2024. Only case reports published in English were included in the study. RESULTS. We found twenty publications with a total of 21 cases that fit the above inclusion criteria for the analysis, with our case being the 22nd. Our patient was a 32-year-old male who presented to the ENT outpatient department with complaints of nasal obstruction for two years. Diagnostic nasal endoscopy was performed and a diagnosis of deviated nasal septum (DNS) to the right and left inferior turbinate hypertrophy was made. He was started on intranasal steroids and decongestants but did not improve. Hence, CT PNS was done and revealed a left inferior concha bullosa along with right-sided DNS. Septoplasty was carried out and the left inferior turbinate was excised. Gross appearance of the turbinate confirmed the diagnosis. CONCLUSION. Pneumatization of the inferior turbinate is a very rare anatomical anomaly. It is often asymptomatic and diagnosed incidentally on a CT scan. It can present as nasal obstruction, recurrent rhinosinusitis, and headaches. Treatment depends on the severity of symptoms.

Paranasal sinus anatomy exhibits numerous variations, and preoperative awareness of these variations is essential for endoscopic sinus surgery. Concha bullosa, an air cell within the nasal turbinates, is most commonly seen in the middle turbinate, affecting 13 to 53.6% of patients. The ethmoid bulla, an air cell in the anterior ethmoid sinus, is anatomically close to the middle turbinate. We present a rare case of a giant concha bullosa containing an ethmoid bulla. A 52-year-old female presented with nasal obstruction and snoring. Examination revealed a slightly deviated septum and a giant concha bullosa in the left middle turbinate. CT scanning confirmed the concha bullosa with an ethmoid bulla inside, as well as a slightly deviated septum. Endoscopic surgery was performed to remove both the concha bullosa and ethmoid bulla. Postoperative recovery was successful, with resolution of her symptoms. Concha bullosa is classified into three types: bulbous, lamellar, and extensive, based on the extent of pneumatization. No classification currently describes a concha bullosa containing another nasal structure, such as an ethmoid bulla. Our case illustrates a unique variation. Paranasal sinus variations are common, and modern imaging allows for better preoperative planning. Recognizing both common and rare anatomical variations, such as the case presented, is crucial for safe and effective sinus surgery.

Cocaine-induced midline destructive lesions: clinical, radiographic, histopathologic, and serologic features and their differentiation from Wegener granulomatosis.

The middle nasal turbinate is an important anatomical formation located on the lateral nasal wall. Concha bullosa can be defined as the presence of an air gap inside the turbinate. It is the most common middle nasal turbinate variation. It is often asymptomatic, but can sometimes cause nasal obstruction. In this study, an asymptomatic patient with concha bullosa within concha bullosa in both middle turbinates, which has not been reported before in the literature, is presented. Laryngoscope, 134:3516-3518, 2024.

Inferior turbinate hypertrophy and concha bullosa often occur opposite the direction of nasal septal deviation. The objective of this retrospective study was to determine whether a concha bullosa impacts inferior turbinate hypertrophy in patients who have nasal septal deviation. The electronic medical record was used to identify sinus CT scans exhibiting nasal septal deviation for 100 adult subjects without and 100 subjects with unilateral middle turbinate concha bullosa. Exclusion criteria included previous sinonasal surgery, tumor, sinusitis, septal perforation, and craniofacial trauma. Nasal septal deviation was characterized in the coronal plane by distance from the midline (severity) and height from the nasal floor. Measurement differences between sides for inferior turbinate width (overall and bone), medial mucosa, and distance to the lateral nasal wall were calculated as inferior turbinate hypertrophy indicators. The cohorts with and without concha bullosa were similarly matched for age, sex, and nasal septal deviation severity, though nasal septal deviation height was greater in the cohort with concha bullosa than in the cohort without concha bullosa (19.1 ± 4.3 mm versus 13.5 ± 4.1 mm, P < .001). Compensatory inferior turbinate hypertrophy was significantly greater in the cohort without concha bullosa than in the cohort with it as measured by side-to-side differences in turbinate overall width, bone width, and distance to the lateral nasal wall (P < .01), but not the medial mucosa. Multiple linear regression analyses found nasal septal deviation severity and height to be significant predictors of inferior turbinate hypertrophy with positive and negative relationships, respectively (P < .001). Inferior turbinate hypertrophy is directly proportional to nasal septal deviation severity and inversely proportional to nasal septal deviation height. The effect of a concha bullosa on inferior turbinate hypertrophy is primarily mediated through influence on septal morphology, because the nasal septal deviation apex tends to be positioned more superior from the nasal floor in these patients.

Concha bullosa is the pneumatisation of intranasal conchae (usually the middle turbinate, and rarely the inferior or superior turbinate); however, the term is generally used to describe aeration of the middle concha. Superior concha bullosa is a rare finding, and only a few cases of inferior concha bullosa have been reported in the medical literature. When symptomatic, concha bullosa may cause various problems including nasal congestion, headache, postnasal drip, anosmia and, sometimes, epiphora. Computed tomography, following history-taking and physical examination, is a valuable tool in diagnosing turbinate pneumatisation. This article presents a very rare case with bilateral triple conchae pneumatisations. The symptomatology, diagnosis and treatment options for cases of multiple concha bullosa are discussed. The surgical interventions performed in the presented case are briefly described. The presented patient had pneumatisation of all six turbinates. In such cases, we propose that this condition be termed 'conchae bullosis' rather than 'conchae bullosa', in a similar fashion to the use of nasal polyposis as the plural form of nasal polyp.

Pneumatization of the intranasal turbinates or concha bullosa is an anatomic variation of the lateral nasal wall. Concha bullosa is defined as the presence of air cells in turbinates. It can be best diagnosed with paranasal sinus computed tomography. Concha bullosa is a possible etiologic factor for recurrent sinusitis due to its negative effect on paranasal sinus ventilation and mucociliary clearance. Concha bullosa is most commonly seen in the middle turbinate and less frequently in the inferior or superior turbinate. Pneumatization of all turbinates is very rare. To our knowledge, there are only two publications about a case with concha bullosa in all turbinates in the current literature. Here, we present a woman with bilateral pneumatization in all three intranasal turbinates.

After the widespread use of endoscopic sinus surgery and paranasal sinus computed tomography, many variations of nasal turbinates have been described. In addition to the most common one-middle turbinate pneumatization (concha bullosa)-superior and inferior turbinate pneumatizations have also been described. Secondary and accessory middle turbinates that can mimic real middle turbinate are anomalies described in recent years. Paradoxical middle turbinate and bifid inferior turbinate are very rarely encountered anomalies and can be easily recognized in paranasal tomography but can be overlooked by endoscopical examination. In the present study, the computed tomography images of 384 patients were evaluated for nasal turbinate variations, as well as their relations to mucosal pathologies. The most frequent variation was found to be concha bullosa; the least frequent one was found to be bifid inferior turbinate. In 1 of our patients, 5 of the 6 turbinates were found to have pneumatization, which is extremely rarely encountered in the literature. In this study, the prevalence of the variations of the turbinates and their association with chronic rhinosinusitis were investigated.

This study was conducted to evaluate whether concha bullosa (CB) and nasal septum pneumatization (NSP) have an impact on nasal septum deviation (NSD) and to determine the prevalence of CB and NSP in a subgroup of the Turkish population in the Mediterranean region. CBCT images of 230 patients were evaluated retrospectively for the presence of CB, NSP and NSD. CB was defined as the presence of any size of pneumatization within the superior, middle, or inferior turbinate. CB laterality, NSP, NSD, age and gender were also recorded. Data analysis was performed with SPSS. Statistical significance was considered to be p < 0.05. 66.5 % of the patients had at least one CB, 59.1% of the patients had NSP and 50% of the patients had NSD. While there was no significant difference between the prevalence of concha bullosa and nasal septum pneumatization and gender, there was a significant difference between the prevalence of nasal septum pneumatization and age (p = 0.026). There was no relationship between NSD and CB and NSP. Despite the hypothesis that CB and NSP impact NSD, this study indicates that there is no relationship between NSD and CB/NSP.

Concha bullosa (CB) is pneumatization of the middle turbinate and one of the most common anatomic variation of the sinonasal region. It is found in about 25% of the population. Middle meatus obstructive syndrome (MMOS) is, usually connected with CB. The main symptoms of this syndrome are headaches, impaired nasal breathing and hyposmia. Headache is the most common symptom and it may occur due to contact between a CB and other structures of the nasal cavity. We presented a case of 32 year-old-woman with headaches, located in the orbital and the left frontal region. The headaches were intermittent and corresponding to the nasal cycle. After neurologic and allergic examination, endoscopic nasal examination demonstrated a septal deviation to the right side and a large middle turbinate in the left side of the nasal cavity. Coronal computerized tomography (CT) of the paranasal sinuses demonstrated the septal deformation and pneumatization of the left middle turbinate. Diagnosis was confirmed by lidocaine test. In the functional endoscopic surgery (FESS), the lateral lamela of the anterior CB was removed. At the same time, the septoplasty was done. At the control examination, the patient was without symptoms. Although CB is the common anatomic variation of the nasal cavity, MMOS is rare. Headache (rhinogenic origin) is the most important symptom. Surgical treatment is the lateral resection of the CB in the FESS technique and the septoplasty.