Pneumatization Of Middle Turbinate Research Articles

Prevalence of concha bullosa in a pediatric population

ObjectiveExisting literature on the prevalence of middle turbinate pneumatization, or concha bullosa (CB), in the pediatric population is limited. CB is an anatomic variant important to identify prior to sinonasal surgery and is often associated with congenital nasal septal deviation (SD). This paper aims to describe the prevalence of CB in the pediatric population on head imaging. MethodsA retrospective chart review was performed for 695 children undergoing CT head for trauma from 2021 to 2022. Nearly equal numbers of males and females were evaluated, with at least 19–20 per year from 0.5 to 18 years. Patients with significant facial fractures, sinusitis, craniofacial syndromes, prior sinus surgery, and sinonasal masses were excluded. Two pediatric neuroradiologists evaluated the CTs. CB was defined as aeration >50 % of the vertical height of the middle turbinate. ResultsIn this study, 384 patients were included. The prevalence of CB was 153 (39.8 %), which was significantly higher in children >4 years (p < 0.0001). Lamellar type CB was the most common, present in 160 out of 768 middle turbinates assessed (20.8 %). SD occurred in 60 (39.2 %) patients with CB and was more commonly contralateral to the CB. ConclusionsThe prevalence of CB in the pediatric population is at the lower range of what is reported in the adult literature. The most common type of CB in patients is lamellar. Similar to previous studies, there is an association between CB and contralateral SD. Finally, there is a positive correlation between the severity of CB and the severity of SD.

Evaluation of infraorbital canal types and their relation with adjacent structures: A cone beam computed tomography study

Aim: This study aims to analyze infraorbital canal (IOC) types in patients with cone beam computed tomography (CBCT) records and to investigate the potential relationship between adjacent structure variations such as mucosal thickening, Haller cells, sinus septa, middle turbinate pneumatization (MTP) and IOC types. Methods: Bilateral evaluation of 197 CBCT records was conducted to assess mucosal thickening, Haller cells, sinus septa, middle turbinate pneumatization (MTP), and IOC types. IOC types were categorized into three classes based on their extent of protrusion into the maxillary sinus: type 1, entirely within the sinus roof; type 2, located below and adjacent to the sinus roof; and type 3, suspended from the sinus roof and descending into the sinus cavity. Results: The distribution of IOC types was as follows: 67.5% for type 1, 22.6% for type 2, and 9.9% for type 3. No significant correlation was observed between IOC types and MTP, mucosal thickening, or the presence of Haller cells. However, a significant relationship was noted between Type 3 IOC and the presence of septa. The occurrence of septa in the maxillary sinus was 8.3% for type 1 IOCs, 13.5% for type 2 IOCs, and 43.6% for type 3 IOCs (p

Computed Tomography Based Evaluation of the Anterior Group of the Paranasal Sinuses

Objective: The study aims to ascertain the prevalence of paranasal sinus variations among healthy adults in the Turkish population, as well as to analyze the symmetry of these variations. Methods: The CTIs of 200 adult patients who did not have any trauma, carcinoma, tumor, surgery, or a condition that could affect the paranasal anatomy, such as chronic rhinosinusitis, were included. The prevalences of the Agger nasi cell (ANC), supraorbital ethmoid cell (SOEC), Haller's cell (HC), middle turbinate pneumatization, and frontal sinus (FS) agenesis variations in the adult Turkish population were revealed. Results: Bilateral SOECs were found 38.5% of 200 patients, and at least 53% of patients had SOECs on one side. In 21.5% of instances, LCs were observed on both sides; in 35% of instances, they were observed on at least one side. ANCs were observed bilaterally in 68.5% of the total, the rate of patients with ANC on at least one side was 84.5%. The rate of bilaterality of the Haller cell (HC) was 24%, it was observed at least one side in 43% of the cases. Bilateral concha bullosa (CB) were observed in 19% while CB variation on at least one side was 42%. Bilateral absence of the FS was found to be 8.5%, and unilateral absence was 2.5%. Conclusion: The most common paranasal sinus variation was ANC, while the least was FS agenesis. Bilateral inheritance was found to be most prevalent in SOEC. The findings of our study hold significance for interventional procedures involving the paranasal region.

The prevalence of middle turbinate pneumatization in patients of Southern region of Saudi Arabia

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; The aim of the study was to determine the prevalence of middle turbinate pneumatization in patients of Southern region of Saudi Arabia.&lt;strong&gt; &lt;/strong&gt; &lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; This study used a retrospective radiological design to analyze computed tomography scans of 117 patients aged between 18 and 80 years of Southern region in Saudi Arabia were used in this study. Patients with altered anatomy (iatrogenic or pathological) were excluded, CT scans were analysed to determine the prevalence of middle turbinate pneumatization in patients of Southern region of Saudi Arabia. &lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; There were forty percent (40%) male cases and sixty percent (60%) female cases. Concha bullosa (CB) was discovered in 17 (14.5%) of the cases, with 4 cases (23%) being bilateral and 13 (76%) being unilateral. 7 (53%) of unilateral cases were on the right side, while 6 (47%) were on the left.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; CB was discovered in 17 (14.5%) of the cases, in patients of Southern region of Saudi Arabia, most of them unilateral by 76%. That’s indicate there is significant number of patients have CB and surgeon should consider it one of his differential diagnosis in patient with nasal obstruction.&lt;/p&gt;

Sinonasal Anatomic Variations According to Frontal Sinus Pneumatization in a Korean Population

Background and Objectives It is necessary to understand the variations of the paranasal sinuses (PNS) and other anatomical structures during an endoscopic sinus surgery (ESS). The purpose of this study was to investigate any association between the degree of frontal sinus (FS) pneumatization and the development of the PNS structures. Subjects and Method We analyzed 311 PNS computed tomography (CT) scans (622 sinuses, including the left and right sides). We classified FS into type I (aplasia), type II (hypoplasia), and type III (control). We assessed and compared the middle turbinate pneumatization (MTP), superior turbinate pneumatization (STP), agger nasi cell (ANC), infraorbital cell (IOC), optic nerve (ON) type, and vidian nerve (VN) type with the pneumatization of the FS. We further studied for any association between the degree of pneumatization of the FS, maxillary sinus (MS), and sphenoid sinus (SS) and the lateral lamella length (LLL). Results MTP, ANC, and IOC rates according to the FS types were not significant (p&gt;0.05). Both type II and III showed more frequent occurrences of STP than type I (p=0.005). The ON type III and IV were significantly frequent in the FS type III (p&lt;0.001). The occurrence of VN type III in the FS type I was significant (p&lt;0.001). When comparing the pneumatizations of FS with MS or SS, there were no significant correlations between them (p&gt;0.05). In the FS type II and III, the LLL was significantly greater than in type I (p&lt;0.001).Conclusion Increased FS pneumatization shows greater indentation of ON and VN into the SS, as well as increased LLL. During ESS, it is important to recognize the possibility of structural damage of ON, VN, and LLL according to FS pneumatization.

Turbinoplasty of concha bullosa: a useful adjunct in improving nasal airway

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Concha bullosa is the pneumatisation of middle turbinate which causes crowding and obstruction of the middle meatus. This is associated with contralateral septal deviation. The objective of this study is to evaluate, if a concha bullosa turbinoplasty has any added value in improving nasal symptoms when performed as adjunct with septoplasty.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; Retrospective analysis of the hospital database was done and details of patients who underwent septoplasty along with concha bullosa turbinoplasty was collected and the patients were telephonically contacted to record their symptom improvement. &lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; Details of nineteen patients who underwent concha bullosa turbinoplasty with septoplasty were studied, mean age of the patients was 31.26 years and the mean follow up period was 22 months. All patients had improvement in symptoms with most completely asymptomatic, the others had mild to moderate symptoms.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; Concha bullosa turbinoplasty as an adjunct to septoplasty does alleviate the symptom of nasal obstruction.&lt;/p&gt;

An Analysis of Association Between Nasal Bone Morphology and Sinonasal Anatomical Variations.

The goal of this study was to investigate the association between various sinonasal anatomical variations and the morphological features of lateral nasal bone, using paranasal computerized tomography (PNCT) sections. Two hundred and fifty patients who underwent a PNCT scan because of a prediagnosis of nasal septum deviation or sinusitis were included in the study. For each patient, presence of the following anatomical variations was determined on CT sections: length and thickness of nasal bone, thickness of intermediate nasal bone, pneumatized middle turbinate, paradox middle turbinate, Agger nasi cell, Haller cell, Onodi cell, supraorbital cell, pneumatized uncinate process, and nasal septal deviation. The effect of each anatomical variation on the length and thickness of the lateral nasal bone was investigated. The patients with bilateral pneumatized middle turbinate and the patients with bilateral Agger nasi cell had a thinner lateral nasal bone both on the right and the left sides compared to those without. The patients with bilateral Onodi cell and Agger nasi cell had a longer lateral nasal bone both on the right and the left sides compared to those without. The nasal bone thickness was significantly thicker on the deviation side than the contralateral nasal bone. The nasal bone length was significantly longer on the side of the septum deviation. In this study, we found that sex, presence of Agger nasi and Onodi cells, pneumatization of middle turbinate, and direction of nasal septal deviation influenced the morphology of the nasal bone. For successful nasal surgery, careful examination of preoperative anatomical variations is very important.

Assessment of the superior turbinate pneumatization and concomitant nasal pathologies on computed tomography

Aim: Knowledge of the anatomical variations of the nasal cavity is extremely important for the safety and ease of endoscopic sinus surgery applications. The aim of the current study was to evaluate the incidence and uni/bilaterality of superior nasal turbinate pneumatization (STP). In addition, we aimed to investigate the frequency of middle turbinate pneumatization (MTP), nasal septum deviation (NSD) and paradoxical middle concha (PMC), and to relate the presence of these pathologies to the presence of STP. Methods: We retrospectively reviewed the images of 358 consecutive patients who undertaken paranasal sinus computed tomography within five months’ time in our institution. The presence and uni/bilaterality of the STP and MTP as well as the presence of NSD and PMC were noted. The relation of the STP with MTP, NSD and PMC were evaluated. Besides, the relationship between nasal variations and gender and age was evaluated.Results: Of 358 patients, 105 (29.3%) had STP with 51 (48.6%) being bilateral and the remaining 54 (51.4%) being unilateral. The number of patients with accompanying MTP, NSD and PMC were 84 (80%), 63 (60%) and 32 (30.5%), respectively. No significant relationship between STP with NSD or PMC was recorded. However, STP significantly associated with MTP. We also noted that the patients with either STP or MTP were significantly younger than those without STP or MTP.Conclusion: The knowledge of the variations of the structures that determine the nasal cavity anatomy and how often these variations are seen will enable the endoscopic surgical procedures to be performed easily and safely.

Rare anatomic variation: Giant unilateral concha bullosa superior

The lateral nasal wall attaches the nasal turbinates, which could be, either pneumatized, or paradoxically curved. The turbinate pneumatization-concha bullosausually indicates the pneumatization of the middle turbinate. However, concha bullosasuperior (CBS) is also, although rare, anatomic possibility of variation. We report here a case of unilateral giant septated CBS, which was not, to our knowledge, previously reported. The case was documented in Cone Beam Computed Tomography (CBCT). Subtle pneumatizations of inferior turbinates were found bilateral, as also were the middle conchae bullosae. The left concha bullosasuperior was very large (17.43/5.34mm), dropping down between the left middle turbinate and the contralaterally deviated nasal septum, and contacting the paradoxical curvature of the middle turbinate on that side. An incomplete oblique septum divided it incompletely into anterior and posterior chambers, it was communicating with a posterior ethmoid air cell, and was draining in the superior meatus. Care should be taken not to misdiagnose a giant CBS as a middle turbinate pneumatization, in order not to misjudge surgical corridors. Therefore, a careful anatomic CT or CBCT diagnosis would be of use for the plan of treatment.

The association of superior attachment of uncinate process with pneumatization of middle turbinate: a computed tomographic analysis.

The frontal sinus outflow pathway is complex and can be influenced by the configuration of the uncinate process (UP). The UP can attach superior to the lamina papyracea, skull base, and middle turbinate. The factors associated with superior attachment remain unclear. This study analyzed the relationships between different types of superior UP attachment and characteristics of the surrounding structures including the agger nasi cell, skull base, and middle turbinate. This retrospective study utilized computed tomography images of 836 sides with identifiable sinus structure from 434 Taiwanese patients. Types of superior UP attachment, height of the ethmoid cribriform plate, prevalence of agger nasi cell, and degree of pneumatization of the middle turbinate were analyzed. In the current study, neither the presence of an agger nasi cell nor height of the cribriform plate had significant relationship with superior UP attachment type. However, UP attachment type was statistically significantly associated with pneumatized middle turbinate (PMT) type (p < 0.01). The PMT group had a higher incidence of UP attachment to the middle turbinate (38%) than the non-PMT group (18%). In the extensive PMT group, the incidence of UP attachment to the middle turbinate was high to 49%. In conclusion, superior UP attachment to the middle turbinate was associated with pneumatization of the middle turbinate. The UP has a greater tendency to attach to the middle turbinate in cases with more PMT.

An often neglected area in crooked nose: middle turbinate pneumatization

IntroductionCrooked or deviated nose is a deviation of the nose from the straight vertical position of the face. Extensive pneumatization of the middle turbinate, also called concha bullosa or bullous middle turbinate (BMT) is known to be one of the possible etiologic factors in nasal obstruction, recurrent sinusitis, and headache. There is no study concerning a link between BMT and crooked nose. ObjectiveTo investigate the association between crooked nose and the presence of a BMT. MethodsA total of 199 patients who underwent open septorhinoplasty were retrospectively analyzed. Preoperative paranasal Computerized Tomography (CT) findings, preoperative photodocumentation, and anterior rhinoscopic examination findings were documented. Of the 199 patients, 169 were found to meet the criteria and were included in the study. CT scans were examined to note the presence of BMT, inferior turbinate hypertrophy, and septum deviation (SD). SDs and crooked noses were classified. ResultsNinety-four of 169 patients (56%) presented a crooked nose deformity and seventy-five of 169 patients (44%) presented a straight nose. While 49 (52%) crooked nose patients had a bulbous and extensive BMT, 20 patients with straight nose (26.6%) had a BMT. A statistically significant relationship was found between the presence of crooked nose and BMT, regardless of the side of the disease (p=0.011). ConclusionThis study revealed a link between crooked nose and BMT.

Relationship between Pediatric Concha Bullosa and Septal Deviation

Objectives: Investigate the frequency of pediatric middle turbinate pneumatization and present its possible effect on septal deviation. Methods: Computed tomography (CT) scans of 152 children (younger than 16 years old) were analyzed for the presence of middle turbinate pneumatization and nasal septal deviation. Results: The incidences of lamellar, bulbous, and extensive concha bullosa were 29.6%, 14.5%, and 7.2%, respectively. The data revealed that 53 patients (67.9%) with concha bullosa also had septal deviation as opposed to 50% (37 out of 74 cases) frequency of septal deviation in patients without concha bullosa. Among the 37 patients with right side concha bullosa, 59.5% had a deviated septum to their left side while 21.6% had a deviation to the right side. Out of those patients with concha bullosa on the left side (38 cases), 44.7% had a right side septal deviation and 13.2% had a left-side septal deviation that revealed a significant relationship between the position of concha bullosa and the side where the septum deviated ( P &lt; .001). The comparison of these ratios showed a significant relationship between the occurrence of septal deviation and concha bullosa ( P = .024). Conclusions: A possible relationship was found between middle turbinate pneumatization and the mechanism of development of septal deviation in children.

Concha Bullosa

To assess the frequency and the endoscopic treatment of the middle turbinate pneumatization or concha bullosa. Forty-nine patients (26 males and 23 females) with sinusitis and headache symptoms and axial and coronal computed tomographic scans of the paranasal sinuses and who had an endoscopic examination visit in the outpatient department between January 2005 and July 2007 were included in this study. Functional endoscopic sinus surgery was performed. Nasal tampons were removed 3 days after surgery, and endoscopic examination visits were performed 7, 15, 30, and 60 days after surgical treatment. All the patients presented complaints of chronic nasal obstruction. Eleven patients (5 males and 6 females; 22.4%) presented either a unilateral or a bilateral middle turbinate pneumatization. The surgeons recorded the surgery and each examination visit. In remote controls (12 mo at least), the patients showed a total remission of symptoms. There were no important complications.

Endoscopic Sellar Floor Reconstruction with Concha Bullosa Bone Autograft and Nasal Septal Flap: Technical Case Report

A novel method is introduced for sellar floor reconstruction after expanded endoscopic endonasal transsphenoidal surgery using concha bullosa bone autograft and vascularized, posteriorly based flaps of septal mucoperichondrium. A 62-year-old woman presented to her primary care physician with the insidious onset of enlarging hands and feet, coarsening of facial features, and bilateral carpal tunnel syndrome. Endocrine studies revealed elevated growth hormone (22 ng/mL) and somatomedian-C (810 ng/mL) levels. Brain magnetic resonance imaging displayed a 1.2-cm pituitary adenoma. The patient was diagnosed with acromegaly secondary to a pituitary adenoma and underwent expanded endoscopic endonasal transsphenoidal surgery for tumor resection. Preoperatively, the patient was noted to have abnormal right middle turbinate pneumatization (concha bullosa). Following adenoma resection, the sellar floor was reconstructed using concha bullosa bone autograft resected during the endonasal approach. Bilateral vascularized nasoseptal mucosal flaps were then placed over the sellar floor. In patients with concha bullosa, conchal bone provides a useful substrate for sellar reconstruction after endoscopic endonasal transsphenoidal surgery.

The Prevalence and Clinical Significance of Superior Turbinate Pneumatization on Computed Tomography

Background and Objectives Middle turbinate pneumatization (MTP; concha bullosa) is a common anatomic variation, and superior turbinate pneumatization (STP) was also described. However, there has been little study of the STP and its clinical significance. In this study, we tried to determine the prevalence of STP. We also evaluated whether STP correlates with MTP, inflammation of posterior ethmoid or sphenoid sinus. Subjects and Method Patients with sinonasal symptoms and for whom paranasal sinus computed tomography (PNS CT) scans was performed between August 2008 and January 2009 were evaluated. A retrospective review of CT scans of 112 patients (224 sides) was done for STP, MTP and paranasal sinus haziness. Results We found STP in 37 patients (33%)-bilaterally in 14 and unilaterally in 23 patients, and in 51 out of the 224 sides (22.8%). The prevalence of STP in CT without mucosal hazziness is higher (29%) than that in CT with mucosal hazziness (15%). MTP was found in 70 sides (31.2%). There was no association between the presence of STP and MTP. No correlation was found between STP and posterior ethmoid or sphenoid sinus inflammation. Conclusion STP is a not infrequently found anatomic variation and may not be related with MTP and adjacent sinus inflammation.

Concha bullosa and the nasal middle meatus obstructive syndrome

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.

Relationship between pediatric sinusitis and middle turbinate pneumatization—ethmoidal sinus pyocele thought to be caused by middle turbinate pneumatization

To investigate whether the presence of pediatric middle turbinate pneumatization causes narrowing of the ostiomeatal complex (OMC) and is associated with the development of paranasal sinusitis. CT scans of 190 nasal sides of 95 children (1-15 years old) were analyzed for the presence of middle turbinate pneumatization and mucosal thickness in the paranasal sinus. Middle turbinate pneumatization was detected in nine (4.6%) of the nasal cavities. Only one of these sides was in a patient younger than 10 years of age, while the other eight sides were in patients at least 13 years old. In six of those nine sides with pneumatization, paranasal sinusitis was also found. However, the images showed that in five sides the middle turbinate pneumatization itself did not obstruct the OMC. In addition, the mean +/- standard deviation (S.D.) of the total score for the paranasal sinus opacification on the side which had the middle turbinate pneumatization was 5.67 +/- 2.95. The corresponding value for the 76 sides without pneumatization was 5.29 +/- 2.53, and the difference between these mean total scores was not statistically significant. However, in one side, the OMC was obstructed or narrowed due to the middle turbinate pneumatization, and an ethmoidal sinus pyocele formed on this side. A causal relationship was not found between middle turbinate pneumatization and the mechanism of development of paranasal sinusitis in children. However, in the event that the OMU becomes obstructed at some time, frequent cycles of improvement and aggravation of pediatric paranasal sinusitis may occur and lead to the development of a serious condition.