Large Concha Bullosa Research Articles

A clinical study to compare the efficacy of crushing of middle turbinate with lateral partial turbinectomy for concha bullosa

Background: Concha bullosa (CB), a pneumatized middle turbinate is most common variations of sino-nasal anatomy. Identified in approximately ~35% (range 14-53%) of patients, a large CB cause nasal obstruction, recurrent sinus infections and headache, may develop into mucocele or mucopyocele or affect olfaction. Endoscopic lateral partial turbinectomy (LPT) is the standard procedure for the treatment of CB. However, the recurrence of contact points and postoperative synechiae with subsequent frontal recess obstruction are common complications of this technique. Crushing of a pneumatized turbinate preserves the mucosa, less time consuming and carry less risk of complications. The aim of the study was to compare the efficacy of crushing with LPT for the treatment of CB. Methods: This was a prospective cohort study conducted by convenient sampling in the Department of ENT, KIMS, Hubli, Karnataka, India. In 53 patients, 43 with unilateral and 10 with bilateral CB satisfying the inclusion and exclusion criteria were subjected to either crushing (group A) or LPT (group B). The success of both techniques were compared based on the relief of symptoms assessed by the visual analogue scale, nasal endoscopy and computed tomography (CT) scan after 6 months of surgery. Results: The overall success rate of the outcome was equal between the two groups, with no statistical (p>0.05) difference. Conclusions: Crushing the CB is as efficient as LPT for the treatment of pneumatized middle turbinate. However, surgically crushed CB can get re-pneumatization in some patients.

Multidetector computed tomography (MDCT)

The aim of this study was to (1) detect the prevalence of anatomical variations of nose and paranasal sinuses in Chronic Rhinosinusitis (CRS) on ‘Nasal Endoscopy and Computed Tomography’, (2) study association of anatomical variations of nose and paranasal sinuses in Chronic Rhinosinusitis. This hospital based cross sectional study was performed during the period from January 2020 to October 2022 on patient between 20 to 60 yrs. of age referred to the department of Radiodiagnosis for evaluation of MDCT PNS from Dept. of ENT, S.C.B medical college and hospital Cuttack. Diagnostic Nasal Endoscopy and Computed Tomography of nose and Paranasal Sinuses of 80 patients of chronic rhinosinusitis were studied and results were. Maximum patients included in study population was 20-25 years with male predominance. Deviated Nasal Septum was the most common anatomical variation, which was detected in 70(87.5%) patients on Diagnostic Nasal Endoscopy and Agger nasii cells were observed in 60(75%) patients on Computed Tomography. The other anatomical variations like Concha bullosa 56(70%) were diagnosed both by Diagnostic Nasal Endoscopy. Anatomical variations like deviated nasal septum, agger nasi cells, medialised uncinated process, large concha bullosa were associated with chronic rhinosinusitis.

Concha Bullosa Affects Baseline and Postoperative Quality-of-Life Measures in Surgically Managed Chronic Rhinosinusitis.

Background Concha bullosa (CB) is a prevalent anatomic variant and frequent surgical target in endoscopic sinus surgery (ESS). However, whether CB impacts quality-of-life (QOL) in chronic rhinosinusitis (CRS) is not well established. The purpose of this study was to investigate baseline and post-ESS QOL differences in patients with medically recalcitrant CRS with and without CB. Methods Demographic and surgical characteristics, baseline and postoperative 22-item Sino-Nasal Outcome Test (SNOT-22) scores for 137 patients with CRS who underwent primary ESS at our institution were recorded. Computed tomography (CT) scans were reviewed for Lund–Mackay score and presence of CB. Multiplanar CT was used to measure CB dimensions and estimate volume. Multivariable analysis was performed to identify differences in SNOT-22 overall and symptom-domain scores between patients with upper quartile (≥0.8 mL) CB and without CB. Results CB was found in 37% of patients with mean volume of 0.67 mL. There were no significant differences in distribution of clinicodemographic variables by large CB status. At baseline, large CB was associated with higher SNOT-22 extranasal-rhinologic domain score (9.8 vs 6.0, P < .01). Following ESS, patients with large CB reported greater improvement in SNOT-22 extranasal-rhinologic domain score (multivariable mean absolute improvement 3.8, P = .01; relative 56% vs 30%). Conclusion Patients with medically recalcitrant CRS and concomitant large CB have higher SNOT-22 extranasal-rhinologic domain scores at baseline, but also report greater intradomain improvement exceeding the subdomain’s mean clinically important difference. To our knowledge, this is the first demonstration that CB has a clinically significant impact on QOL in CRS, and surgical intervention may be helpful to address these symptoms.

Large Concha Bullosa Is a Risk Factor for Chronic Sinusitis: A Case Control Study

The study analyzed the correlation between the presence of concha bullosa with the presence of radiological sinus opacity and sinonasal functional symptoms. All patients whose computed tomography (CT) findings were positive for concha bullosa were included in the study. The CT parameters taken in consideration were the presence and volume of concha bullosa, the aspect of the ipsilateral maxillary sinus (normal transparency, presence of sinus opacity). Clinical parameters were sinonasal functional signs. Statistical comparisons were made using the Pearson Chi square test. Over a four years period, 2436 CTs were interpreted, 276 of which presenting a concha bullosa (prevalence of 11.33%). The average age was 33 (19 to 63). Females (204 either 74%) outnumbered men (72 either 26%). An opacification of the ipsilateral maxillary sinus seen upon CT was statistically related to the presence of a large concha bullosa (p = 0.02). On the other hand, the presence of a clinical symptomatology of maxillary sinusitis crossed with the presence of a large concha bullosa was not significant (p ˃ 0.50). This study has demonstrated a close correlation between the existence of a large concha-bullosa and an ipsilateral maxillary sinusitis seen on CT-Scan without necessarily having clinical manifestation of sinusitis. The diagnosis of sinusitis must remain primarily clinical.

Role of Concha Bullosa in Chronic Rhinosinusitis.

cross sectional study. 60. all patients of chronic rhinosinusitis. patients with previous sinus surgeries, malignancy and acute cases of chronic rhinosinusitis.

Evaluation of domestic and Yucatan swine nasal sinus anatomy as models for future sinonasal research of medications delivered by standard instruments used in functional endoscopic sinus surgery

There is a need to find an animal model to study new medications to improve mucosal wound healing after functional endoscopic sinus surgery (FESS). Current literature suggests swine as a potential candidate. The lack of information correlating swine computer tomography (CT) and endoscopic sinonasal anatomy prompted us to investigate them in the domestic and Yucatan swine to determine their feasibility as models to test new medications and drug-embedded stents applied using FESS techniques. Two domestic pig heads and 2 Yucatan pig heads were imaged using helical thin slice (1 mm) CT. Two rhinologists analyzed the images and performed endoscopy on the swine. Particular attention was given to accessing the frontal sinus and suturing stents to the nasal septum using standard endoscopic instruments. CT confirmed that swine sinonasal anatomy is largely similar to human, with all major sinuses present. The middle and inferior turbinates of swine arise from a single uniturbinate. The superior turbinates contain large concha bullosa. Unlike human, swine nasal septum is bone anteriorly and cartilage posteriorly. The frontal sinus ostia, regardless of head size, were consistently around 10 cm from the nasal aperture. On endoscopy, domestic swine frontal sinus ostia were easily accessible for topical medication deposition. Silastic splints can be sutured to the domestic swine septum through the posterior cartilaginous portion, allowing for studies involving medication-eluting material. The narrower nasal cavity of Yucatan pigs prohibited endoscopic maneuvers. Domestic swine, but not Yucatan, are a feasible model for future sinonasal research using standard FESS instruments.

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.

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.

Unusual cause for unilateral nasal obstruction in a child

An unusual presentation of a common anatomical variation presenting as unilateral nasal obstruction in a child of 14 years. Choncha bullosa is a common anatomic variant seen in 34–53%; it can be the cause of the osteomeatal obstruction predisposing to sinusitis and their complications due to mucosal contact points and impairing the mucociliary clearance or causing mechanical obstruction at the osteomeatal complex. Here we are presenting a case of unusually large concha bullosa, which was causing unilateral nasal obstruction, deviated septum and bilateral anterior sinusitis and recurrent chest infection in a 14-year-old girl. The concha bullosa was filled with thick pus making it a pyocele. The culture did not grow any organisms. The CT scan done was not conclusive the origin of the lesion but could be diagnosed only during the surgery.

中鼻甲介蜂巣によるきゅう覚障害２例

Two cases of olfactory disturbance caused by large concha bullosa were reported. Severe stenosis of the olfactory cleft caused by concha bullosa swelling was revealed through coronal scanning by computed tomography (CT). There was little inflammation. Olfactory improvement was correlated with removing the stenosis around the olfactory cleft by endoscopic sinus surgery (ESS). It is considered that detailed examination of the olfactory cleft and coronal scanning by CT are important in cases of olfactory disturbance.

Wedge Resection of the Middle Turbinate—An Adjunct to Functional Endoscopic Sinus Surgery (FESS)

A simple technique of wedge resection of the anterior part of the middle turbinate allows a better access to the Osteo meatal complex (OMC) during FESS procedure. In post-operative period it facilitates proper ethmoid cavity care, mandatory to the success of the endoscopic sinus surgery. The technique keeps the middle turbinate away from the lateral wall of the nose and helps reducing the synechia formations. It also exteriorises the apparent and occult pneumatised middle turbinate. It is a simple and safe procedure to perform with minimal trauma to the middle turbinate without complications attributable to the technique. During functional endoscopic sinus surgery this technique affords improved exposure to the OMC in patients with high deviated septum, narrow nasal vault, a large concha bullosa and paradoxical turbinate.