Polyps arising in a concha bullosa of the middle turbinate. (Rhinoscopic Clinic).

A 38-year-old man came to us with a complaint of midfacial pressure and a history of recurrent sinusitis. He had been treated medically numerous times by his family physician. Computed tomography (CT) of the paranasal sinuses detected an unusual finding: a polypoid formation in the left concha bullosa of the middle turbinate (figure, A). In view of the patient's poor response to medical treatment, he elected to undergo endoscopic sinus surgery.

At surgery, a microdebrider was used to enter the left concha bullosa (figure, B) and later resect the lateral obstructing portion of the mass. When the concha bullosa was entered, well-defined polyps were encountered (figure, C and D). Small polyps were found in the left middle meatus. No communication between the concha bullosa and the nasal cavity existed. Surgery involved an endoscopic resection of the lateral wall of the left concha bullosa, nasal polypectomy, and a left anterior ethmoidectomy. The patient did well postoperatively.

Aeration and subsequent enlargement of the middle turbinate give rise to the relatively common anatomic variant of a concha bullosa. In general, nasal polyps are the most common benign nasal mass. Nasal polyps usually occur in the area of the ethmoid sinus. (1,2) Reports in the literature of polyps arising in a concha bullosa have been infrequent. (3)

Chronic sinusitis resulting from an obstruction of the ostiomeatal complex can require surgical intervention. Resection of the lateral portion of an obstructing concha bullosa is an accepted method of relieving middle meatal obstruction. When removing the lateral portion of the concha bullosa, it is important not to destabilize the remaining medial portion of the turbinate.

References

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

(2.) Yanagisawa E, Christmas DA, Yanagisawa R. Endoscopic view of the sites of origin of nasal polyps. Ear Nose Throat J 2000 ;79:490-2.

(3.) Yanagisawa E. Concha bullosa polyp. In: Yanagisawa E. Atlas of Rhinoscopy: Endoscopic Sinonasal Anatomy and Pathology. Ch. 56. San Diego: Singular-Thompson Learning, 2000.

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 Section of Otolaryngology, Hospital of St. Raphael, New Haven, Conn., and the Section of Otolaryngology, Yale University School of Medicine, New Haven (Dr. Yanagisawa).