Asymmetry of the middle turbinates and ethmoid sinuses.

A 22-year-old man presented with left nasal obstruction and intermittent sinus infections. He denied any nasal injury, but he said he had had left nasal obstruction all his life. Examination revealed a widely patent right nasal airway and compensatory hypertrophy of the middle turbinate (figure, A). The left nasal passage was narrow, and the left middle turbinate was hypoplastic (figure, B). Computed tomography (CT) of the sinuses showed a marked asymmetry of the middle turbinates; the left middle turbinate was markedly hypoplastic (figure, C and D). It also showed bilateral hypoplastic maxillary sinuses and a left hypoplastic ethmoid sinus with mucosal thickening. The left nasal cavity was markedly narrowed secondary to a septal deviation.

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Hypoplasia of the maxillary sinus has been described frequently in the literature. (1) It is easily detected on CT. Hypoplasia of the ethmoid sinus, as was seen in the patient described herein, is not a common condition. The development of the ethmoid sinus can vary significantly. (2) Anatomic anomalies that occur as a result of this asymmetric development can interfere with mucociliary transport and proper sinus function. (3) When approaching cases of abnormal anatomy, it is important that the surgeon take great care during dissection to preserve adjacent mucosa and structures. In our patient, the marked septal deformity in the left nasal airway might have influenced the development of the left ethmoid sinus. It also might have influenced the development of sinusitis.

References

(1.) Proctor T, Naclerio R. Development of a hypoplastic maxillary sinus. Ann Otol Rhinol Laryngol 1996;105:327-8.

(2.) Rice DH, Schaefer SD. Anatomy of the paranasal sinuses. In: Rice DH, Schaefer SD, eds. Endoscopic Paranasal Sinus Surgery. 2nd ed. New York: Raven Press, 1993.

(3.) Knops JL, McCaffrey TV, Kern EB. Inflammatory diseases of the sinuses: Physiology. Clinical applications. Otolaryngol Clin North Am 1993;26:517-34.

From the Department of Otolaryngology. University of South Florida College of Medicine. Tampa, and the Halifax Medical Center, Daytona Beach, Fla. (Dr. Mirante and Dr. Christmas); and the Southern New England Ear, Nose, Throat, and Facial Plastic Surgery Group; the Section of Otolaryngology, Hospital of St. Raphael; and the Section of Otolaryngology, Yale University School of Medicine, New Haven, Conn. (Dr. Yanagisawa).