Endoscopic view of a septated concha bullosa.
A 43-year-old man was referred to us for evaluation of recurring ethmoid sinusitis. Computed tomography (CT) of the sinuses identified an uncommon septated concha bullosa of the right middle turbinate and a hypoplastic septated right antrum (figure, A). Clinical examination revealed a prominent right middle turbinate (figure, B).
The patient elected to undergo functional endoscopic sinus surgery. The concha bullosa was entered anteriorly, revealing an anterior compartment (figure, C) that extended inferiorly below a posterior and superior compartment (figure, D). The lateral portions of both concha compartments were removed, revealing a well-defined ostium of the posterior and superior compartment (figure, E). At the termination of the procedure, the lateral and inferior portion of the right concha bullosa was resected, which allowed for adequate drainage and ventilation (figure, F).
A concha bullosa of the middle turbinate is a relatively common anatomic variant that may be associated with enlargement of the turbinate. Chronic rhinosinusitis may occur in association with a concha bullosa when the middle meatus is subsequently narrowed. (1) Powered instrumentation has been used successfully as a tool for opening and partially removing a concha bullosa, thereby reducing the width of the middle turbinate and allowing for access to the middle meatus if needed. (2) Because its development is related to the ethmoid sinus, a concha bullosa can exhibit various patterns of drainage into the middle meatus of the nasal cavity. (3,4) This case illustrates an interesting anatomic variation of a septated concha bullosa.
(1.) Stammberger HR. Functional Endoscopic Sinus Surgery: The Messerklinger Technique. Philadelphia: B.C. Decker; 1991.
(2.) Mirante JP, Christmas DA, Yanagisawa E. Powered endoscopic turbinate surgery. In: Yanagisawa E, Christmas DA, Mirante IP, eds. Powered Instrumentation in Otolaryngology-Head and Neck Surgery. San Diego: Singular-Thomson Learning; 2001:174-8.
(3.) Christmas DA, Mirante JP, Yanagisawa E. An unusual medial ostium of a concha bullosa of the middle turbinate. Ear Nose Throat J 2002;81(8):491-2.
(4.) Yanagisawa E, Mirante JP, Christmas DA. An unusual lateral ostium of a concha bullosa of the middle turbinate. Ear Nose Throat 12003;82(3):159-60.
Eiji Yanagisawa, MD, FACS; Joseph P. Mirante, MD, FACS; Dewey A. Christmas, MD
From 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); and 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).