Endoscopic view of a powered partial resection of a concha bullosa.

Pneumatization of the middle turbinate, known as a concha bullosa, is a common anatomic variant. It is a good example of how an anatomic variation in the nose does not represent a pathologic state, per se, but can predispose a person to sinusitis. (1) Aconcha bullosa is clinically important when there is significant narrowing of the middle meatus with ostiomeatal-complex obstruction resulting in sinus disease. (2) Surgical intervention may become necessary.

Various techniques for the partial removal of the middle turbinate have been described. (2) A newer surgical technique for the partial removal of the lateral portion of a concha bullosa involves powered instrumentatio. (3)

We evaluated a 40-year-old woman who complained of nasal stuffiness with recurrent sinusitis. She continued to experience symptoms despite repeated antibiotic treatment. Computed tomography of the sinuses revealed pneumatization of both middle turbinates; the one on the right was much larger than the one on the left, and it caused middle metal narrowing (figure, A).

The patient was taken to the operating room for partial resection of the right concha bullosa. A microdebrider was passed into the anterior face of the middle turbinate to open the concha bullosa (figure, B); this procedure is similar to that used to enter the ethmoid bulla during powered endoscopic sinus surgery. The dissection was carried superiorly and laterally, and care was taken to proceed gently so as to not disturb the attachment of the middle turbinate (figure, C). With the lateral portion of the middle turbinate removed, the middle meatus became exposed, and access to the posterior border of the uncinate process was easily achieved (figure, D).

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Use of the microdebrider is well suited to the partial removal of the middle turbinate. Light pressure can be applied to the anterior surface of the concha bullosa, and the portion to be removed can be shaved away with minimal trauma to the remaining middle turbinate and surrounding structures.

Powered endoscopic partial turbinate resection is an effective method of widening the middle meatus by removing the lateral portion of the concha bullosa without destabilizing the remaining portion of the middle turbinate.

References

(1.) Stammberger HR. Functional Endoscopic Sinus Surgery: The Messerklinger Technique. Philadelphia: B.C. Decker; 1991.

(2.) Yanagisawa E. Conchabullosa polyp. In: Yanagisawa E, ed. Atlas of Rhinoscopy. San Diego: Singular-Thomson Learning; 2000:125.

(3.) Mirante JP, Christmas DA, Yanagisawa E. Powered endoscopic turbinate surgery. In: Yanagisawa E, Christmas DA, Mirante JP, eds. Powered Instrumentation in Otolaryngology--Head and Neck Surgery. San Diego: Singular-Thomson Learning; 2001:174-8.

Dewey A. Christmas, Jr., MD; Joseph P. Mirante, MD, FACS, MBA; Eiji Yanagisawa, MD, FACS

From the Department of Otolaryngology, University of South Florida College of Medicine, Tampa, and the Halifax Medical Center, Daytona Beach, Fla. (Dr. Christmas and Dr. Mirante); 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).