Anatomical Variations of the Middle Turbinate Concha Bullosa and its Relationship with Chronic Sinusitis: A Prospective Radiologic Study
29 June 2017
21 December 2017
13 March 2018 (eFirst)
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.
- 1 Joe JK, Ho SY, Yanagisawa E. Documentation of variations in sinonasal anatomy by intraoperative nasal endoscopy. Laryngoscope 2000; 110 (2 Pt 1): 229-235
- 2 Al-Sebeih KH, Bu-Abbas MH. Concha bullosa mucocele and mucopyocele: a series of 4 cases. Ear Nose Throat J 2014; 93 (01) 28-31
- 3 Lee JH, Hong SL, Roh HJ, Cho KS. Concha bullosa mucocele with orbital invasion and secondary frontal sinusitis: a case report. BMC Res Notes 2013; 6 (06) 501
- 4 Unlü HH, Akyar S, Caylan R, Nalça Y. Concha bullosa. J Otolaryngol 1994; 23 (01) 23-27
- 5 Rak KM, Newell II JD, Yakes WF, Damiano MA, Luethke JM. Paranasal sinuses on MR images of the brain: significance of mucosal thickening. AJR Am J Roentgenol 1991; 156 (02) 381-384
- 6 Bolger WE, Butzin CA, Parsons DS. Paranasal sinus bony anatomic variations and mucosal abnormalities: CT analysis for endoscopic sinus surgery. Laryngoscope 1991; 101 (1 Pt 1): 56-64
- 7 Zinreich SJ, Mattox DE, Kennedy DW, Chisholm HL, Diffley DM, Rosenbaum AE. Concha bullosa: CT evaluation. J Comput Assist Tomogr 1988; 12 (05) 778-784
- 8 Van Alyea OE. Nasal sinuses: an anatomic and clinical consideration. Baltimore: Williams and Wilkins; 1951
- 9 Cohen SD, Matthews BL. Large concha bullosa mucopyocele replacing the anterior ethmoid sinuses and contiguous with the frontal sinus. Ann Otol Rhinol Laryngol 2008; 117 (01) 15-17
- 10 Stallman JS, Lobo JN, Som PM. The incidence of concha bullosa and its relationship to nasal septal deviation and paranasal sinus disease. AJNR Am J Neuroradiol 2004; 25 (09) 1613-1618
- 11 Aramani A, Karadi RN, Kumar S. A study of anatomical variations of osteomeatal complex in chronic rhinosinusitis patients—CT findings. J Clin Diagn Res 2014; 8 (10) KC01-KC04
- 12 Nadas S, Duvoisin B, Landry M, Schnyder P. Concha bullosa: frequency and appearances on CT and correlations with sinus disease in 308 patients with chronic sinusitis. Neuroradiology 1995; 37 (03) 234-237
- 13 Lam WWM, Liang EY, Woo JK, Van Hasselt A, Metreweli C. The etiological role of concha bullosa in chronic sinusitis. Eur Radiol 1996; 6 (04) 550-552
- 14 Koo SK, Kim JD, Moon JS, Jung SH, Lee SH. The incidence of concha bullosa, unusual anatomic variation and its relationship to nasal septal deviation: A retrospective radiologic study. Auris Nasus Larynx 2017; 44 (05) 561-570
- 15 Tonai A, Baba S. Anatomic variations of the bone in sinonasal CT. Acta Otolaryngol Suppl 1996; 525: 9-13
- 16 Uygur K, Tüz M, Doğru H. The correlation between septal deviation and concha bullosa. Otolaryngol Head Neck Surg 2003; 129 (01) 33-36
- 17 Lee JS, Ko IJ, Kang HD, Lee HS. Massive concha bullosa with secondary maxillary sinusitis. Clin Exp Otorhinolaryngol 2008; 1 (04) 221-223
- 18 Yasan H, Doğru H, Tüz M, Yeşildağ A, Karahan N. Polypoid degeneration of the middle turbinate mucocele mimicking intranasal neoplasia. J Otolaryngol 2005; 34 (03) 207-209
- 19 Pinto JA, Cintra PP, de Marqui AC, Perfeito DJ, Ferreira RD, da Silva RH. [Mucopyocele of the middle turbinate: a case report]. Rev Bras Otorrinolaringol (Engl Ed) 2005; 71 (03) 378-381
- 20 Erkan AN, Canbolat T, Ozer C, Yilmaz I, Ozluoglu LN. Polyp in concha bullosa: a case report and review of the literature. Head Face Med 2006; 2 (02) 11
- 21 Ceylan S, Bora F, Batmaz T, Atalay B. Complex Concha Bullosa. Otolaryngol (Sunnyvale) 2012; 2: 109
- 22 Kantarci M, Karasen RM, Alper F, Onbas O, Okur A, Karaman A. Remarkable anatomic variations in paranasal sinus region and their clinical importance. Eur J Radiol 2004; 50 (03) 296-302
- 23 Armengot M, Ruiz N, Carda C, Hostalet P, Basterra J. Concha bullosa mucocele with invasion of the orbit. Otolaryngol Head Neck Surg 1999; 121 (05) 650-652
- 24 Aktas D, Kalcioglu MT, Kutlu R, Ozturan O, Oncel S. The relationship between the concha bullosa, nasal septal deviation and sinusitis. Rhinology 2003; 41 (02) 103-106