Endoscopic view of an infected concha bullosa.

A 38-year-old woman presented with a 2-year history of recurring pain medial to the right eye and associated nasal congestion. Her family physician had treated her repeatedly with antibiotics, but the resolution of symptoms was only temporary.

Clinical examination revealed the presence of a concha bullosa of the right middle turbinate (figure, A). Computed tomography (CT) showed that the sinuses were clear, but the right middle turbinate was partially filled with secretions (figure, B). In view of the recurring nature of her symptoms, the patient elected to undergo a partial resection of the infected right middle turbinate; this was accomplished with a microdebrider (figure, C). Intraoperative findings included the presence of thick inspissated material that had filled the inferior two-thirds of the right middle turbinate (figure, D). At the termination of the procedure, the lateral and inferior portions of the right concha bullosa had been resected, providing adequate drainage and ventilation.

[FIGURES A-D OMITTED]

A concha bullosa of the middle turbinate is a common finding in the nose. By narrowing the middle meatus, such a lesion can predispose a patient to sinusitis. (1) When a concha bullosa is suspected of causing recurrent middle meatal and sinus obstruction, the middle meatus can be widened with a partial resection. We have previously described an effective technique forpartial resection of the lateral portion of a concha bullosa using powered instrumentation. (2)

It is believed that a concha bullosa of the middle turbinate usually drains directly into the ethmoid sinus. (1) Variations of this drainage pattern have been described? (3,4) When drainage and ventilation of a concha bullosa are disturbed, the concha bullosa might become infected and cause recurrent sinus headache.

The case described here involved an unusual isolated recurrent infection of a concha bullosa without involvement of the paranasal sinuses.

References

(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 JP, eds. Powered Instrumentation in Otolaryngology-Head and Neck Surgery. San Diego: Singular-Thomson Learning; 2001:174-8.

(3.) Yanagisawa E, Mirante JP, Christmas DA. An unusual lateral ostium of a concha bullosa of the middle turbinate. Ear Nose Throat J 2003;82:159-60.

(4.) Christmas DA, Mirante JP, Yanagisawa E. An unusual medial ostium of a concha bullosa of the middle turbinate. Ear Nose Throat J 2002;81:491-2.

Dewey A. Christmas Jr., MD; Joseph P. Mirante, MD, FACS; 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).