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

Abstract Introduction: The 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. Objective: The 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. Methods: Surgical 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. Results: It 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). Conclusion: This 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.

Assessing the efficacy of a modified crushing technique for the management of concha bullosa: a cone beam computer tomography study / Avaliando a eficácia de uma técnica de esmagamento modificada para o manejo da concha bolhosa: um estudo com tomografia por feixe cônico

Abstract Introduction: Although many surgical techniques exist to manage obstructive concha bullosa, there continues to be a drive to find the least invasive technique with the fewest complications and best results. Objectives: The purpose of this study is to describe and assess the short- and long-term efficacy of a modified crushing technique for concha bullosa management. Methods: Patients who met inclusion criteria underwent a detailed nasal examination and cone beam computed tomography imaging prior to and after septoplasty with crushing surgery for obstructive concha bullosa. Patients were divided into short- and long-term groups based on their followup period such that the short-term group had a mean followup of 15.14 months (range 6->22 months) and the long-term group had a mean followup of 56.66 (range 29->80) months. Results: Twenty-four cases of obstructive concha bullosa were included in this study with 13 short-term and 11 long-term follow-ups. All patients showed a significantly decreased postoperative CB size (p< 0.001). There was no correlation between age and postoperative CB change in area (p = 0.39) and no significant difference in the amount of postoperative CB area reduction between the short-term and long-term groups (p = 0.35). No patients experienced bleeding, synechia, conchal destruction, or olfactory dysfunction on followup evaluations. Conclusion: Our modified crushing technique is a simple, effective, and lasting treatment option for concha bullosa. From our experience, there have been no complications and no instances of concha bullosa reformation during the follow-up period.

Resumo Introdução: Embora existam muitas técnicas cirúrgicas para o tratamento da concha bolhosa, ainda se busca encontrar uma técnica menos invasiva com menor número de complicações e melhores resultados. Objetivos: Descrever e avaliar a eficácia em curto e longo prazo de uma técnica de esmagamento modificada para o manejo da concha bolhosa. Método: Os pacientes que preencheram os critérios de inclusão foram submetidos a exame nasal detalhado e tomografia computadorizada de feixe cônico antes e após septoplastia com cirurgia de esmagamento de concha bolhosa. Os pacientes foram divididos em grupos de curto e longo prazo de acordo com o período de seguimento, de modo que o grupo de curto prazo teve um seguimento médio de 15,14 meses (intervalo de 6 a 22 meses) e o grupo de longo prazo teve uma média de seguimento de 56,66 (variação de 29 a 80) meses. Resultados: Vinte e quatro casos de concha bolhosa foram incluídos neste estudo, com 13 seguimentos de curto prazo e 11 de longo prazo. Todos os pacientes apresentaram uma redução significante no tamanho da concha bolhosa no pós-operatório (p< 0,001). Não houve correlação entre a idade e a mudança na área da concha bolhosa no pós-operatório (p = 0,39) e nem diferença significante na redução da área da CB no pós-operatório entre os grupos de curto e longo prazo (p = 0,35). Nenhum paciente apresentou sangramento, sinéquia, destruição da concha ou disfunção olfatória nas avaliações de seguimento. Conclusões: Nossa técnica de esmagamento modificada é uma opção de tratamento simples, eficaz e duradoura para a concha bolhosa. Com base nessa experiência, não houve complicações e qualquer caso de recorrência na formação da concha bolhosa durante o período de seguimento.

Is there a relationship between middle concha bullosa and ethmoid roof asymmetry? / Existe uma relação entre a concha média bolhosa e a assimetria do teto etmoidal?

Abstract Introduction The middle turbinate and ethmoid roof are intranasal structures and may have many anatomical variations. These structures, which serve as anatomical markers during functional sinus surgery, are important for preventing complications and performing a proper surgery. Knowledge of anatomical variations will increase surgical success and reduce complications. Objective We aimed to investigate the presence of asymmetry in the ethmoidal roof and anatomical variation in patients with and without concha bullosa. Methods In this study, the files of patients who underwent paranasal computed tomography between 2012 and 2018 were analyzed retrospectively. The patients were divided into two groups, as patients with and without concha bullosa. Differences between the two groups in terms of age, gender, septum deviation, ethmoid artery dehiscence, ethmoid roof asymmetry were examined. Results The 369 patients included in our study were divided into two groups; those with concha bullosa and those without concha bullosa. The mean age of the patients with concha bullosa was 36.1 ± 13.4 (min-max: 12-74) and the mean age of patients without concha bullosa was 37.5 ± 14.3 (min-max: 10-81). The ethmoid roof depths were compared between the two groups and a significant difference was observed (p < 0.001). The ethmoid roof depth was higher in the group with concha bullosa (p < 0.001). Conclusion The results of our study indicate that the ethmoidal roof tends to be higher in patients with middle concha bullosa.

Resumo Introdução A concha média e o teto etmoidal são estruturas intranasais e podem apresentar muitas variações anatômicas. Essas estruturas, usadas como marcadores anatômicos durante a cirurgia sinusal funcional, são importantes para evitar complicações e para a feitura adequada da cirurgia. O conhecimento das variações anatômicas aumenta o sucesso cirúrgico e reduz as complicações. Objetivo Investigar a presença de assimetria no teto etmoidal e variações anatômicas em pacientes com e sem concha bolhosa. Método Os prontuários dos pacientes submetidos à tomografia computadorizada de seios paranasais entre 2012 e 2018 foram analisados retrospectivamente. Os pacientes foram divididos em dois grupos, pacientes com e sem concha bolhosa. As diferenças entre os dois grupos em termos de idade, sexo, desvio do septo, deiscência da artéria etmoidal e assimetria do teto etmoidal foram avaliadas. Resultados Os 369 pacientes incluídos em nosso estudo foram divididos em dois grupos: com concha bolhosa e sem concha bolhosa. A média de idade dos pacientes com concha bolhosa foi de 36,1 ± 13,4 (mín-máx: 12-74 anos) e a média de idade dos pacientes sem concha bolhosa foi de 37,5 ± 14,3 (mín-máx: 10-81 anos). As profundidades do teto etmoidal foram comparadas entre os dois grupos, observou-se diferença significante (p < 0,001). Observou-se que a profundidade do teto etmoidal foi maior no grupo com concha bolhosa (p < 0,001). Conclusão O resultado do nosso estudo indica que pacientes com concha média bolhosa tendem a apresentar uma maior profundidade do teto etmoidal.

A review of common anatomical variants of paranasal sinuses and nasal cavity and its frequency of occurrence as evidenced on multi-detector computed tomography

This study was carried out to know the frequency of occurrence of common anatomic variants in computed tomography of paranasal sinuses and nasal cavity. Non contrast Computed tomography (CT) of paranasal sinuses of 100 patients referred to Department Of Radiology, Saveetha Medical College were retrospectively studied. The Multi-detector computed tomography (MDCT) scans were evaluated for various anatomical variants of paranasal sinuses and nasal cavity. The frequency of occurrence was calculated in percentage.We found out that deviated nasal septum (DNS) was the most common variant in this study, seen in 86% of cases, followed by Agger nasi cells which was seen in 56% and the third most common was supra-orbital ethmoidal cells seen in 42% of the study population. All the cases included in the study, had minimum of one variant. Most of the study population showed multiple anatomical variations of paranasal sinus and nasal cavity. In conclusion, multidetector Computed tomography plays an important role is the assessment of various anatomical variants of the paranasal sinuses and nasal cavity. Pre-operative MDCT of Paranasal sinuses, gives the surgeons most if not all of the anatomical information they need to tailor surgeries. Considering the relatively high frequency of occurrence of these variants, it is essential for the radiologists to have a precise knowledge of imaging features of normal anatomy and anatomical variants of Paranasal sinuses.

To Assess the Anatomical Variations of Paranasal Sinuses on Computed Tomography: A Retrospective Analysis

Background: Paranasal sinuses are a group of four paired airfilled, mucosa lined spaces surrounding the nasal cavity. Thepneumatization or hypoplasia of the sinuses affects thedrainage pathways, causing chronic infections andcomplications. The aim of the present study was to assess theanatomical variations of paranasal sinuses on computedtomography.Materials and Methods: The present retrospective study wascarried out over the period of 6 months using 80 CBCT imagesof patients, with their age group ranging from 20-50 yearsreferred for different oral diagnostic purposes. An assessmentof paranasal sinuses and it’s variations were accuratelycharacterized in axial, coronal and sagittal sections. The datawas analysed statistically using SPSS 21 software and Chisquare test was used to find the statistical significance.Results: In the present study total participant were 80 in which56.25% were having anatomical variation. 8.75% were havingvariation in agar nasi cells,10% were having variation in Kuhncells, 7.5% were having variation in Onodi cells, 5% werehaving variation in haller cells, 10% were having variation inconcha bullosa, 12.5% were having variation in nasal septumdeviation, 20% were having variation in maxillary sinus septa,17.5% were having variation in sphenoid sinus pnematization,2.5% were having variation in maxillary sinus pnematization,6.25% were having variation in Crista galli pneumatisation.Conclusion: This study concluded that imaging of the PNS willaid in diagnosis in individual patients, and also provide adeeper understanding of the manifestations of the disease.

Anatomical Variations in Nose and Paranasal Sinuses in Patients Presenting with Chronic Rhinosinusitis

Introduction: The anatomy of organs of ENT is a herculeantask to understand and evaluate in the whole human anatomy.Knowledge about the possible variabilities is never complete,since there is always a scope to understand better and knowmore. Many studies have been undertaken in the past tounderstand better the already existing knowledge about thevarious anatomical details in the nose and paranasal sinusescausing chronic rhinosinusitis. The present study was carriedto know the details of variations in anatomy of nose andparanasal sinuses causing chronic sinusitis.Material and Methods: A Cross sectional study conductedover a period of two years, in patients presenting to ENTOPD with symptoms and signs and chronic rhinosinusitis, ina setting of tertiary hospital, with the requisite investigativeprotocols. Patients meeting the inclusion criteria were includedin the study and subjected to the prescribed interventions.Results: Observations gathered from this study are- of the65patients included, 86.1% had septal deformities, 58.4% hadConcha bullosa, 52.3% had Agger Nasi, 15.3% had HallerCell, 13% had Paradoxical Middle Turbinate, 4.6% hadEverted Uncinate Process, 3% had Enlarged Bulla.Conclusion: Sinonasal anatomy is different in each individual,with various combined variations also.

Mucocele of Concha Bullosa: A Case Report

MUCOELE in middle turbinate is rare occurrence. Most common site is frontal sinus. Next comes the ethmoid sinus. It occurs due to obstruction of drainage pathway of sinuses causing retention of secretion lead to its formation. It commonly present with very common complaints similar to other diseases of nose such as nasal obstruction and headache. Pre-endoscopic era it was very difficult to examine it properly, CT is the investigation of choice. It was successfully treated endoscopically.

Importância do complexo osteomeatal no planejamento do levantamento de seio maxilar / Importance of the evaluation of the osteomeatal complex in the planning of maxillary sinus lift

O desvio de septo nasal, concha bolhosa e a obstrução do óstio são alterações do complexo osteomeatal, que podem interferir no volume dos seios maxilares, em sua oxigenação, drenagem adequada de fluidos e nos resultados de cirurgias nessa região. A adoção de um protocolo de avaliação do complexo osteomeatal envolvendo uma equipe multidisciplinar no planejamento de cirurgias de levantamento de seio maxilar pode proporcionar a diminuição do surgimento de complicações pós-operatórias relacionadas à drenagem e ventilação, prejudicadas pelo desvio de septo nasal, concha bolhosa e obstrução do óstio.

Nasal septum deviation, concha bullosa and ostium obstruction are alterations of the osteomeatal complex that may interfere with the volume of the maxillary sinuses, their oxygenation, adequate drainage of fluids and the results of surgeries in this region. The adoption of a protocol for evaluation of the osteomeatal complex involving a multidisciplinary team in the planning of surgeries of maxillary sinus can provide a reduction in the appearance of postoperative complications related to drainage and ventilation impaired by nasal septum deviation, concha bullosa and obstruction of the ostium.

A Case of Osteoblastoma Accompanied with Concha Bullosa of the Inferior Turbinate / 대한이비인후과학회지

Osteoblastoma is a rare benign tumor, representing less than 1% of all bone tumors. Most cases occur in the vertebrae and in the long bones. Intranasal or paranasal osteoblastoma is particularly rare and only one case of osteoblastoma in the inferior turbinate has been reported in the world literature. Treatment is intralesional curettage or en bloc resection. Since the tumor is benign, conservative surgery is curative in about 80-90% of the cases. Concha bullosa is an abnormal pneumatization of the intranasal turbinates and inferior concha bullosa is a very rare condition. We report an unusual case of osteoblastoma occurring together with inferior concha bullosa. The tumor and inferior concha bullosa were removed by endoscopic submucosal inferior turbinoplasty, with favorable results. Related articles are reviewed and brief discussions are presented in regards to the case findings.

Accidental middle turbinectomy by nasotracheal intubation: A case report

Nasotracheal intubation is an anesthetic technique widely used for maxillofacial surgery. It has the advantage of easier access to the surgical site to surgeon. However, when the nasothracheal intubation is performed a few complications may occur, such as nasal mucosa damage, epistaxis, sinusitis by sinus drainage occlusion and transient bacteremia. In addition, concha bullosa is a common anatomic variant of the middle turbinate, which is pneumatized, and very susceptible to trauma. We report a case of accidental middle turbinectomy by nasotracheal intubation, in the patient who had bilateral concha bullosa.

A Case of Giant Concha Bullosa Causing Complete Unilateral Obstruction of Nasal Cavity / 대한이비인후과학회지

The term concha bullosa describes aerated turbinate and it is most common on middle turbinate. Symptoms of concha bullosa depends on the amount of pneumatization and location. Concha bullosa without symptoms does not need surgical treatment, however, surgical treatment is indicated when it causes nasal obstruction. There are many reports of concha bullosa because it is a common anatomic variation. Despite many reports of concha bullosa, there is no definite statistics on the size of concha bullosa, and there has been no reports on what its largest size is. This report deals with a giant concha bullosa of middle trubinate of 4.5 cm in length, 2.2 cm in width size causing complete nasal obstruction.

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

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

Massive Concha Bullosa with Secondary Maxillary Sinusitis

Concha bullosa is a common anatomic variation of the middle turbinate; however, sinusitis secondary to the concha bullosa is rare. A 52-yr-old woman presented with nasal obstruction and posterior nasal drip. Computed tomography and examination of the nasal cavity revealed septal deviation on the left side, and a massive concha bullosa and maxillary sinusitis on the right side. The lateral lamella of the affected turbinate was removed and the inspissated material was drained. Histopathologic examination of the excised lesion in the concha bullosa revealed bacterial colonies in the mucus plug. We report here on a massive concha bullosa with secondary maxillary sinusitis.

Concha Bullosa: Incidence and Relationship with Chronic Sinusitis on OMU CT

Concha bullosa is one of the most common anatomical variations detected in the paransal sinus and nasal cavity. In this study, the incidence of concha bullosa and the relationship between the size of concha bullosa and the degree of the paranasal sinus lesion is to be inquired. This study was based on 232 patients who visited our outpatient department with rhinological symptoms suspected with chronic sinusitis who went under OMU CT. Based on OMU CT reviews, the grade of concha bullosa was divided into four stages and the paransal sinus lesion was classified into 5 stages. The prevalence rate of concha bullosa was 36.2% with 14.6% bilateral and 21.6% unilateral. The accompanying incidence of concha bullosa in patients with no sinus disease was 20.2% and 26.8% in sinusitis patients, with no significant statistical difference between the two groups. Merely, a higher prevalence rate was seen in patients with paranasal sinus lesions localized in the OMU. However, for a more accurate result as of concha bullosa functioning as an etiological factor of sinusitis, a random population based study will be necessary. Also, it has been noticed that septal deviation, in all anatomical variations, most commonly occurs in patients with concha bullosa.

A Case of Conchal Mucocele with Exophthalmos / 대한이비인후과학회지

An enlarged pneumatized middle turbinate, termed "concha bullosa" is a relatively common anatomical variant. It may be the site of inflammatory disease ranging from simple mucosal thickening to a mucocele. But a conchal mucocele is a rare disease such as mucoceles of the posterior ethmoid and sphenoid sinus. The mucociliary transport within a concha bullosa is usually toward the conchal ostium located on the anterosuperior aspect of the middle turbinate and in most cases it opens into the frontal recess. Chronic obstruction of a conchal ostium can lead to a mucocele. Chronic pressure within the mucocele can cause the walls of the middle turbinate to expand, further destructing bulla, other ethmoid cells, and lamina papyracea. Authors have experienced one case of a conchal mucocele with anterior ethmoid and frontal recess extension which presented with exophthalmos. We performed functional endoscopic sinus surgery. Postoperatively, exophthalmos was spontaneously corrected.

The Relationship between Clinical Patterns of Sinusitis and Anatomical Variation / 대한이비인후과학회지

BACKGROUND: With the advent of functional endoscopic sinus surgery, the importance of the ostiomeatal unit(OMU) has been known. Anatomic abnormalities, irreversible inflammatory changes, or obstruction of ostiomeatal unit lead to sinus ostial obstruction and subsequent chronic or recurrent sinusitis. For these reasons, septal deviation, concha bullosa and paradoxical middile turbinate may compress the uncinate process and occlude the infundibulum and then they may induce anterior paranasal sinusitis. OBJECTIVES: This study was conducted to evaluate the relationship between the existence of anatomical variations of sinonasal regions and Babbel's five patterns of chronic sinusitis based on coronal plane CT and to be helpful in treatment of chronic sinusitis. MATERIALS AND METHOD: From february 1994 to February 1996, Coronal plane CT scans of 150 patients with bilateral sinonasal disease were retrospectively reviewed. We examined anatomical variations-paradoxical middle turbinate, concha bullosa, and septal deviation-using PNS CT and analyzed the finding of PNS CT based on Babbel's five patterns of chronic sinusitis. One patient with bilateral sinonasal disease was considered as two different cases. RESULTS: In consequence of this study, the existence of anatomical variations don't show any influence on the paranasal sinusitis patterns. CONCLUSION: This study suggests that the existence of anatomical variations may not be significantly associated with respective incidence of the paranasal sinusitis patterns and may similarly influence in each patterns of chronic sinusitis.