Middle Turbinate Concha Bullosa Research Articles

Characterising Sinonasal Pneumatization in Patients with Nasal Septal Deviation: A CBCT-Based Study.

This study aimed to investigate the presence and correlation of paranasal sinus pneumatization among patients with and without nasal septal deviations (NSD), to enhance clinical understanding of sinonasal anatomical variations. It is descriptive, retrospective study under a monocentric, utilizing institutional archives. 30 subjects with NSD and 30 without NSD were selected. Inclusion criteria required diagnostic quality Cone Beam Computed Tomography (CBCT) images, while exclusion criteria included developmental anomalies, central pathology, previous sinonasal surgery, fractures, and non-diagnostic images. The Assessment of Pneumatization of the Paranasal Sinuses (APPS) score was used to evaluate anatomical variations in paranasal sinuses based on CBCT scans. Statistical analysis was performed using the Chi-square test and independent t-test via SPSS version 23. A significant association between NSD and certain anatomical variations was observed. Notably, higher prevalence rates of variations such as pneumatization of the maxillary floor, middle turbinate concha bullosa, and superior frontal sinus wall were found in subjects with NSD. Statistical significance was confirmed in seven out of nine parameters, with p-values < 0.001 for most comparisons. The left side exhibited greater pneumatization than the right. The total APPS scores showed strong statistical significance between groups (p < 0.001). The study reveals a significant relationship between nasal septal deviation and paranasal sinus pneumatization, suggesting that septal deviations may influence the extent of pneumatization in the sinonasal complex.

CT of Anatomic Variants of Sinonasal region and its correlation with symptoms of Rhinosinusitis

Background: Sinonasal region is subjected to wide anatomical variation. The paranasal sinuses (PNS) create a connection with nasal cavity. They are placed in close proximity to nose. The four paranasalsinuses ;maxillary, ethmoid, sphenoid, and frontal, are named after their coinciding bone. Computed Tomography (CT Scan )is important modality to describe the location of these paranasal sinuses. Aim: To ascertain the frequency of various anatomic variants of sinonasal region in population of Sahiwaland itsassociation with symptoms of rhinosinusitis. Methods: This descriptive cross sectional study was conducted in Sahiwal Teaching Hospital from 10th June 2022 – 10th December 2022, with collaboration of Radiology and otorhinolaryngeology Departments. 60 symptomatic subjects between 18-60 years of age, irrespective of gender with rhinosinusitiswere taken.They underwent CT Scan of paranasal sinuses. The findings of CT Scan related to nasal-septum, turbinates, uncinate process, ethmoid air-cells and other anatomical variants corresponded with symptoms of rhinosinusitis. The data was analyzed using SPSS version 23.0. Frequency, percentages and p-value of different variants were calculated. The p-value of ≤ 0.05 was considered as significant. Results: Our study showed 63.3% males and 36.7% females. The mean age of our subjects was 30.65 + 12.7 years. The most frequently seen anatomical variants in our population were nasal septum deviation (86.7%) followed by aggernasi cells (68.3%) and asymmetry of both sides of sphenoid sinuses (68.3%). The statically significant association was noted between concha bullosa of middle turbinate and nasal obstruction ( p-value 0.001) and between rhinorrhea and asymmetry of both sides of sphenoid sinus ( p-value 0.035) Practical Implications &amp; Conclusion: We concluded from our study that that however there is no significant association between rhinosinusitis and most of the anatomic variants of sinonasal region except concha bullosa of middle turbinate and asymmetry of both sides of sphenoid sinus. But to avoid operative complexities, a surgeon must be well aware of these diverse variants. Keywords: Anatomical variations, CT-scan, Rhinosinusitis

Endoscopic appearance of duplicated middle turbinate, case series and literature review.

Duplication of the middle turbinate is an extremely rare condition encountered in rhinology clinic. Knowledge and awareness of the nasal turbinates' variations are important to perform a safe endoscopic surgery and evaluate patients with inflammatory sinus diseases. Case series of two patients who visited rhinology clinic in academic university hospital. Case 1: presented with 6-month history of nasal blockage. Nasal endoscopy revealed bilateral duplication of the middle nasal turbinates. Computed tomography scans showed bilateral medially curved and anteriorly folded uncinate process, and right middle turbinate concha bullosa and its superior end of the middle turbinate was turned medially. Case 2: A 29-year-old gentleman presented with nasal obstruction mainly to the left side for several years. Nasal endoscopy showed bifid right middle turbinate and severe deviated nasal septum to the left. Upon imaging, a sinus computed tomography scan demonstrated a duplication of the right middle turbinates in the form of two middle nasal concha. Different rare anatomical variations can occur at different points during the embryological development. These rare variations include double middle turbinate, accessory middle turbinate, secondary middle turbinate, and bifid inferior turbinate. The appearance of double middle turbinate can be encountered in rhinology clinic only 2% of the time. Upon reviewing the literature, only few case reports were found regarding the double middle turbinate. A double middle turbinate has important clinical implications. Anatomical variation may lead to narrowing in the middle meatus which makes the patient vulnerable to sinusitis or maybe associated with secondary symptoms. We report rare cases of middle turbinate duplication. Awareness of the nasal turbinates' variations is important for detection and management of inflammatory sinus diseases. Further studies are needed to identify the association of other pathology.

Rhinogenic Contact Point Headache – a Review

Headache is a universal symptom in the course of everyone's life. There are myriads of causes for headache ranging from simple migraine, tension headache, refractory errors in the eye, temporomandibular joint arthralgia, and myofascial spasm to severe form of headache by brain tumors. The anatomical variations in the nasal cavity result in mucosal contact between the opposing surface and cause rhinogenic contact point headache (RCPH). RCPH is a new type of headache in medical literature. The pathogenesis of the RCPH is still the subject of controversy. Nose has diverse anatomical variations. Deviated nasal septum or spur, middle turbinate concha bullosa, and enlarged bulla ethmoidalis are the common anatomical variation in the nasal cavity which can cause RCPH. Diagnostic nasal endoscopy and computed tomography scan are helpful to confirm the mucosal contact points inside the nasal cavity. The precise excision of the contact points with the help of endoscopic approach in patients of RCPH is very effective. Clinicians should not ignore the anatomical variation of the nasal cavity during management of the headache. There is not much literature for RCPH indicating that this clinical entity is neglected. This review article presents an overview of the current aspect of RCPH.

Relationship between the Superior Attachment of the Uncinate Process and Pneumatization of the Middle Turbinate—A Radiological Study

Objective: the superior attachment of the uncinate process (SAUP) is highly variable. Lateral types of SAUP are associated with frontal rhinosinusitis. SAUP in the middle turbinate is more common when the middle turbinate is aerated. We aim to refine these findings by studying the relationship between the SAUP type and the different subtypes of pneumatization of the middle turbinate. Methods: 200 CT sinonasal scans were analyzed by an otolaryngologist and a radiologist. All CT scans were analyzed to study the type of the middle turbinate concha bullosa and lamellar cell and the type of SAUP. Results: 379 sides were analyzed. The prevalence of the various types of SAUP were: Type I: 43.80%, Type II: 22.16%, Type III: 16.36%, Type IV: 3.69%, Type V: 9.76%, and Type VI: 4.22%. When studying the pneumatization of the middle turbinate and the SAUP types, we only found a statistically significant association between the lateral attachment of the uncinate process and the presence of a lamellar cell (p = 0.029). Conclusion: lateral types of SAUP are more likely in the presence of a lamellar cell. This finding, therefore, renders checking for lateral SAUP types in the presence of a lamellar cell even more relevant than when studying the pre-surgical CT scan. In those cases, it is advisable to perform a careful and complete uncinectomy.

CT SCAN EVALUATION OF CONCHA BULLOSA AND ITS CORRELATION WITH DEVIATED NASAL SEPTUM – A PROSPECTIVE STUDY

Introduction : Osteomeatal unit is a functional unit of the anterior ethmoid complex representing the final common pathway for the drainage and ventilation of the frontal, maxillary and anterior ethmoid cells .Osteomeatal complex has become an area of active radiologic and pathophysiologic investigation with the development of endoscopic sinus surgery for inflammatory sinus disease. The aim of this study was to investigate the anatomical vari Aim : ation of the middle turbinate concha bullosa , incidence of concha bullosa and its correlation with nasal septal deviation. based on paranasal sinus imaging. A prospective study was performed in the Department of ENT and Materials and Methods : Head Neck Surgery over a period of 5 years, to determine the prevalence of Concha bullosa in patients who presented to our out patient department with symptoms of nasal obstruction, headache, post nasal drainage and facial pain , and underwent CT scan of Paranasal sinuses. We evaluated 462 CT images both coronal and axial planes with a 1-3-mm slice thickness. Out of the CT scans studied of the nose and paranasal sinus of 462 patients, the prevalen Results : ce of concha bullosa was 25.5 % (118) patients .Male predominance was seen with 63 (53.3%) patients and 55 (46.6%) female patients. Concha bullosa was bilateral in 21 (17.7%) patients, and unilateral in 76 (64.4 %) patients. Mixed or extensive type of concha bullosa was seen in 56 (47.4%) patients followed by 35 (29.7%) patients having lamellar type and 27 (22.9%) patients with bulbous type.Out of 118 cases of CB, 43 (36.4%) were on left side of which 29 (67.4%) patients showed deviation of the nasal septum to right and 33 (27.9%) were on right side of which 21 (63.3%) patients had a nasal septal deviation to left. We found that there is a strong relationship between the presence of unila Conclusion : teral or dominant Concha bullosa and contralateral nasal deviation.

Rhinogenic Contact Point Headache in Pediatric Age

Background: Headache is a common clinical entity seen among pediatric patients in routine clinical practice. The pressure of two opposing mucosa in the nasal cavity even in the absence of inflammation can be a cause of headache, which is called a rhinogenic contact point headache. Anatomical variations of the nose such as rhinogenic contact point headache may result in headache due to the contact of the nasal mucosa which often missed during the evaluation of the pediatric patients. Objective: The aim of this study is to assess the rhinogenic contact point headache in the pediatric age group. Materials and Methods: This is a prospective study and 112 children with rhinogenic contact point headache enrolled in this study. This study conducted at a tertiary care teaching hospital during September 2018–October 2021. The anatomical variations of the nose were evaluated with help of diagnostic nasal endoscopy and computed tomography (CT) scan. These anatomical variations in rhinogenic contact point headache were treated surgically. Results: Out of 112 children with rhinogenic contact point headache, 31 (27.67%) had deviated nasal septum, 28 (25%) had septal spur, 20 (17.85%) middle turbinate concha bullosa, 11 (9.82%) enlarged ethmoidal bullosa, 11 (9.82%) had hypertrophied inferior turbinate, 7 (6.25%) had hypertrophied super turbinate, and 4 (3.57%) had nasal septal bullosa. Treatment of each child with rhinogenic contact point was personalized for every patient. Conclusion: Headache is a common clinical symptom and is nearly universal in the life of a child. The contact between opposing mucosa in the nasal cavity in the absence of inflammation can result in headache and/or facial pain in the pediatric age group. Endoscopic excision of the contact points of nasal cavity is effective for the treatment of rhinogenic contact point headaches.

Olfactory neuroepithelium in the middle turbinate: is there any impact on olfaction function after lateral marsupialization for concha bullosa surgery?

IntroductionThe effect of the quantity of olfactory neuroepithelium in the middle turbinate on the postoperative olfactory function for middle turbinate concha bullosa patients has not yet been evaluated. ObjectiveThe primary aim of this study was to investigate the olfactory structures in the middle turbinate by immunohistochemical analysis of the olfactory marker protein and to correlate the immunostaining results with the olfaction test results for patients with middle turbinate concha bullosa. MethodsSurgical materials of 18 middle turbinate concha bullosa patients who had undergone lateral marsupialization surgery were immunostained with olfactory marker protein antibodies. Smell diskettes olfaction test was applied to all of the study group patients both preoperatively and three months postoperatively. A visual analog scale was used to quantify the sense of nasal obstruction. ResultsIt was observed that the postoperative smell scores and the nasal obstruction visual analog scale values were significantly improved as compared to the preoperative values (p < 0.05). In addition, there was a significant correlation between the smell score gain and the visual analog scale gain values (r = 0.682). Results also indicated no significant correlation between the olfactory marker protein staining scores and the smell scores (p > 0.05). ConclusionThis first paper demonstrated that the quantity of the olfactory mucosa in the middle turbinate was not a determining factor for the postoperative smell function degree for middle turbinate concha bullosa patients. The underlying cause of the olfactory deficit for middle turbinate concha bullosa patients seems to be obstruction related rather than the middle turbinate’s olfactory mucosa containing status.

Middle turbinate concha bullosa and its relationship with chronic sinusitis: a review

&lt;p class="abstract"&gt;Sinonasal diseases are serious health issues found in the clinical practice. Sinonasal diseases are often associated with anatomical variants in the sinonasal tract. There are numerous sinonasal anatomical variants found frequently in computed tomography (CT) scans of the paranasal sinuses. Middle turbinate concha bullosa is a common anatomical variant found in the nasal cavity. Pneumatization of the middle turbinate is called as concha bullosa. The pneumatization of the middle turbinate is mostly via the anterior ethmoidal air cells. Pneumatizations through posterior ethmoid air cells are also reported. There are three types of concha bullosa such as lamellar, bulbous and extensive. Majority of the patients with middle turbinate concha bullosa are asymptomatic. Sometimes this is accidentally detected during proper evaluation of the headache. Sometimes the middle turbinate concha bullosa is associated with chronic sinusitis. However, there are very few literatures which correlate the middle turbinate concha bullosa and chronic sinusitis. Although chronic sinusitis is a clinical diagnosis, the imagings like CT scan are useful to assess the extent of the disease and demonstrate the sinonasal anatomy. CT scan of the paranasal sinuses and diagnostic nasal endoscopy are important tests useful for evaluation of the middle turbinate concha bullosa and its relations with chronic sinusitis. This review article discusses on the details of the middle turbinate concha bullosa and its relationship with chronic sinusitis.&lt;/p&gt;

Sino-Nasal Anatomical Variations in Rhinogenic Headache Pathogenesis.

Rhinogenic headache (RH) is a widespread pain syndrome but its pathogenesis and treatment are still unclear. Some authors recognize a correlation between RH and mucosal contact points or some other sinonasal anatomical variations. The authors conducted a retrospective case-control study to analyze the correlation between radiological findings and clinical symptoms.One hundred-nineteen adults with Para-Nasal Sinuses Computed Tomography (PNS-CT) scans were included: 64 patients who have originally undergone PNS-CT scan as part of rhinogenic headache workup (Group A), and 55 controls in whom PNS-CT scans were obtained for other purposes (Group B). All subjects were asked to report their symptoms using a headache scoring system. PNS-CT scans of all subjects were analyzed for presence of mucosal contact points, middle turbinate concha bullosa (MTCB) and frontoethmoidal cells.The most common anatomical abnormality found in our series was MTCB, reported in 60.9% of patients in Group A and 41.8% of those in Group B. A statistically significant prevalence was found in Group A compared to Group B regarding the presence of MTCB (P = 0.037) and Type II (P = 0.016) and Type III (P = 0.039) frontoethmoidal cells. No statistically significant difference (P >0.05) was found between Group A and Group B regarding the presence of mucosal contact points at each site.Multiple anatomical variations in nasal and paranasal sinuses may cause a rhinogenic headache with different characteristics. Some of these, such as concha bullosa of middle turbinate or type II and III Kuhn cells, have shown a significant association with rhinogenic headache. No statistically significant association was found between presence of headache and mucosal contact points and type I and IV frontal cells. These findings can be very helpful for the surgeons that want to deal with the treatment of RH.

Major Structural Airway Pathologies of Patient Complaining Nasal Obstruction: Analysis of Frequency, Preoperative Complaints and Benefit from Surgery.

Modern rhinoplasty has an aesthetic and a functional component that cannot be separated. Functional rhinoplasty generally concentrates on optimizing nasal airflow. Numerous techniques have been described for correction of each pathology. There seems to be a consensus on the benefit of surgery to patients with nasal obstruction. Present study aimed to determine if specific airway pathologies have differential effects on patient complaints and techniques addressing them have differential effects on perceived benefit from surgery. The records of 300 patients complaining nasal obstruction and had computerized tomography (CT) between April 2015 and April 2018 were retrospectively reviewed. Based on surgical notes, surgical techniques used for each patient were recorded. A survey using Nasal Obstruction Symptom Evaluation (NOSE) scale is done by phone. After descriptive statistics, preoperative complaint-diagnosed pathology, and postoperative relief-treated pathology relationships were evaluated. Preoperative and postoperative NOSE scores showed statistically significant difference (P <0.001). The CT analysis showed that septal deviation rate among patients complaining nasal obstruction is 85%, internal valve insufficiency rate is 34.4%, mild and severe inferior turbinate hypertrophy was 71% and 6%, respectively. Bullous and total concha bullosa of middle turbinate was 17.3%. Nearly 90% of patients had 2 or more types of pathology in CT analysis. Preoperative and postoperative NOSE scores showed no statistically significant relationship with singular intranasal pathologies and techniques used for correcting them, respectively. Despite general fall in NOSE scores in the whole study group, treatment of a specific pathology does not change NOSE score more than a patient who already does not have the pathology. None of the pathologies or treatments addressing them have a dominating effect on preoperative complaints or obtained relief after the surgery. So, success of functional rhinoplasty cannot rely on correction of a specific pathology. A comprehensive analysis and correction of every pathology is paramount.

Comparative Study between lateral laminectomy and conchoplasty in the surgical treatment of symptomatic middle turbinate Concha Bullosa

Objective: To evaluate and compare the short term outcomes of lateral laminectomy (partial turbinectomy) and conchoplasty (turbinoplasty) techniques in the surgical treatment of symptomatic middle turbinate concha bullosa.Background: Concha bullosa (pneumatized nasal turbinate) is one of the most common anatomical variants of the lateral nasal wall which occurs mainly at the middle turbinates.The effective method to control symptomatic Concha bullosa is mainly surgical via various techniques.Patients and Methods: This prospective study was carried out on 40 patients from October 2016 till April 2018. All patients who were presented with symptomatic concha bullosa, and then subjected to preoperative clinical, endoscopical, radiological assessment and by using an evaluation tests . Patients were divided equally and randomly into two groups, group A for lateral laminectomy and group B for conchoplasty, and all of them were arranged to postoperative re-evaluation follow up visits after 3 and 6 months.Results: The mean age group of our studied patients was 31.8 ±8.4 years. (37.5%) of patients were male, while (62.5%) of them were female. The most recorded postoperative complications in group A were development of nasal crustations (35%) and synechia formation (20%),the postoperative minimal epistaxis was more in group A (15%) than in group B (5%).Conclusion: Conchoplasty is an effective, safe and conservative procedure for the surgical treatment of symptomatic concha bullosa with anatomical and physiological preservation of the middle turbinate.

Is there any effect of neurotrophin-3 on the pathogenesis of non-allergic nasal polyps?

Although the role of neurotrophins such as nerve growth factor and brain-derived neurotrophic factor in nasal polyps development has been studied, the contribution of neurotrophin-3 has not been evaluated yet. This study aimed to investigate the possible role of neurotrophin-3 in nasal polyps pathogenesis. The study group comprised 70 non-allergic nasal polyps patients and the control group consisted of 53 patients with middle turbinate concha bullosa. Specimens were taken, during surgery, from the ethmoid sinus nasal polyps in the nasal polyps group and from the lateral part of the middle turbinate concha bullosa in the control group. Tissue and serum levels of neurotrophin-3 were assessed by immunohistochemistry and enzyme-linked immunosorbent assay, respectively. Nasal polyps patients had higher tissue neurotrophin-3 scores (p < 0.001). There was no statistically significant difference between groups regarding serum neurotrophin-3 levels (p = 0.417). Tissue neurotrophin-3 staining scores in the nasal polyps group had no statistically significant correlation with Lund-Mackay scores (p = 0.792). Neurotrophin-3 may have a local effect in nasal polyps pathogenesis, without joining systemic circulation.

Anatomical Variations of the Middle Turbinate Concha Bullosa and its Relationship with Chronic Sinusitis: A Prospective Radiologic Study.

Introduction A pneumatized turbinate, also called concha bullosa, is a normal anatomical variant of the paranasal sinus region. Depending on the site of pneumatization, the concha is classified into extensive, bulbous or lamellar type. The middle turbinate concha bullosa has been implicated as a possible etiological factor in chronic sinusitis. Objectives The aim of this study was to investigate the anatomical variations of the concha bullosa, based on paranasal sinus imaging, and its possible association with sinusitis. Methods This prospective descriptive study was performed at the Department of ENT and Head Neck Surgery over a period of one year, from 2016 to 2017. We studied the computed tomography scans of the nose and paranasal sinuses— in axial, coronal and sagittal planes—of patients who had symptoms of nasal obstruction, or headache and features of chronic sinusitis. Results Out of the 202 scans studied, the prevalence of concha bullosa was 31.7%. The concha was bilateral in 35 (54.7%) patients and unilateral in 29 (45.3%) patients. Out of 99 conchae, 54 were on the right side and 45 were on left side. Ipsilateral sinusitis was found in 40.4% of the sides in the scans of subjects with concha. There was no statistically significant association between any type of middle turbinate concha with sinusitis, but sinusitis was more predominant with the extensive type of concha ( p > 0.05). Conclusion Multiple air cells, mucocele, pyocele and inflammatory mucosal thickenings in the concha are relatively rare. Detailed knowledge of anatomic variations of the concha bullosa is imperative for the radiologists and the operating surgeons.

The incidence of concha bullosa, unusual anatomic variation and its relationship to nasal septal deviation: A retrospective radiologic study

ObjectiveIdentifying anatomical variations associated with pathological findings is very useful for diagnoses and therapeutics. We conducted a study to detect various anatomical variations (superior, middle, inferior turbinate concha bullosa, uncinate bulla and nasal swell body [NSB]) in connection with nasal septal deviation. MethodsThis study used a retrospective radiological design to analyze 594 (1188 sides) osteomeatal computed tomography scans from 494 male patients and 100 female patients aged between 17 and 75 years. We randomly selected 100 male and 100 female patients as controls; we compared the groups and performed a statistical analysis. All patients in the control group had sinusitis only (i.e., they lacked nasal septal deviations). ResultsLeft-sided septal deviation was found to be slightly more prevalent than right-sided deviation (43.9% and 36.4%, respectively). The incidence of S-curved septal deviation was 18.5%, that of dorso-ventral deviation was 10.9%, and that of caudal-rostral deviation was 7.6%. The incidence of only septal spur was 1.2%. In the case of middle turbinate concha bullosa, the incidence of the unilateral type was 17.3% and that of the bilateral type was 36.4%. In superior turbinate concha bullosa, the incidence of the unilateral type was 11.3% and that of the bilateral type was 27.4%. The incidence of inferior turbinate concha bullosa was 1.0% and that of uncinate bulla was 1.7%. NSB was found in 25.1% of patients, 24.7% of males and 27.0% of females. The frequencies of middle and superior concha bullosa were about 10–12 fold higher on the concave side. The nasal septal deviation group exhibited a higher incidence of most anatomical variants than the non-deviated group; differences in the middle turbinate concha bullosa attained statistical significance. ConclusionThe radiologist must focus on anatomical variants in the preoperative evaluation. It is important for surgeons to be aware of these variations.

The Impact of Middle Turbinate Concha Bullosa on the Severity of Inferior Turbinate Hypertrophy in Patients with a Deviated Nasal Septum.

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.

A Case of Middle Turbinate Headache Syndrome Caused by Middle Turbinate Concha Bullosa Included Fungal Ball

A Case of Middle Turbinate Headache Syndrome Caused by Middle Turbinate Concha Bullosa Included Fungal Ball

Clinical Aspect of Concha Bullosa of Middle Turbinate and Nasal Septal Deviation

Objectives: Concha bullosa (CB) with nasal septal deviation (NSD) can be the cause of postoperative functional failure if not corrected during surgery. Methods: All the paranasal computed tomography scans (CTs) taken in a tertiary hospital from May 2011 to October 2012 were analyzed. Cases with history of nasal surgery and nasal trauma were excluded due to the possibilities of nasal anatomical changes. Results: 520 CTs were included in this study, from 550 CTs analyzed. 331 males and 189 females were included, and the ages of patients ranged from 2 to 87. 444 patients (85.38%) had NSD. The age distributions of CB were as follows: in the age group of 0~15, 0%; 16~30,.70%; 31~45, 40%; 46~60, 33.14%; and over 60 years, 25%. In 444 patients with NSD, bilateral CBs were observed in 93, unilateral CBs in wide nasal cavity in 47, and narrow nasal cavity in 7. When 269 CBs were classified as true, lamella, or bullous type, the average measured pneumatization areas were statistically wider in true type (p=0.008). When comparing the maximum pneumatization areas of CB in coronal CT of patients with NSD, the CB area of wide side nasal cavity was statistically wider than that of narrow side nasal cavity ( P = 0.000). Conclusions: CBs are clinically thought to be formed in those over 15 years old. CBs are formed mainly in wider nasal cavity, and especially larger in true type, so they should be removedin surgery.

Middle Turbinate Evacuation Conchoplasty in Management of Contact-Point Rhinogenic Headache in Children

Background: Our objective is to evaluate the efficacy and outcomes of endoscopic evacuation of middle turbinate "concha bullosa" compared with lateral partial turbinectomy, in children with chronic contact-point headaches. For the research, this study is using prospective clinical trial and setting in Otolaryngology department, Tanta University Hospital, Egypt. Methods: Over three years, 60 children underwent surgery for management of contact-point rhinogenic chronic headache resulting from middle turbinate concha bullosa, using either an evacuation technique (30 children) or lateral partial turbinectomy (lamellectomy technique, 30 children) with at least 12 months' follow up. Post-operative adhesions, olfactory disorders, pain intensity, and frequency and duration of headache attacks were monitored. Results: None of the children of the evacuation group developed post-operative synechia or olfactory disorders. In the lamellectomy group, two children reported reduced olfactory capacity and an additional four children had developed adhesions. Pain intensity and frequency and duration of headache attacks improved significantly in both groups (pre- vs post-operative results), but significantly more so in the evacuation group. Conclusion: The evacuation technique may be superior to the lamellectomy technique in preventing post-operative synechia and olfactory disorders, as well as better relieving of pain intensity and frequency and duration of headache attacks. doi: http://dx.doi.org/10.4021/ijcp53w

The relationship between anatomical variations of the sino-nasal region and chronic sinusitis extension in children

To report the prevalence of paranasal sinus anatomic variations and their relationship with the extent of chronic sinusitis in pediatric population. This is a prospective study of all the cases of persistent pediatric chronic sinusitis despite medical therapy that presented to the otolaryngology clinics of King Abdullah University Hospital in Irbed, Jordan, and had coronal computed tomography examination of the nose and paranasal sinuses as part of their diagnostic or preoperative work up, between the periods of April 2006 and August 2007. Sixty-five cases met inclusion criteria and were analyzed. Cases were further subdivided into three groups according to age. Group 1: with ages from 5 to 7 years; group 2: ages 8-12; and group 3: above 12 years. The scans were analyzed for the presence of anatomical variations, and disease extension. Correlation between anatomical variations and disease extension was the primary outcome measure. There were 30 boys and 35 girls with an average age of 11.4 (age ranges from 5 to 16). The maxillary sinus was the most commonly involved sinus, followed by the ethmoid, sphenoid, and frontal sinuses. Agger nasi cell was the most common anatomical variation, followed by concha bullosa of middle turbinate. The frequency of most of these variants differed widely between groups 1 and 2, groups 1 and 3, but not between groups 2 and 3. No significant correlation was found between these anatomical variants and the extent of chronic sinusitis. Anatomical variations in the nose and paranasal sinuses are common in children with chronic sinusitis. Although the prevalence of these variations changes during childhood development they are unlikely to predict the extent and severity of chronic rhinosinusitis in pediatric age group.