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Endoscopic view of a drainage pathway of a concha bullosa.

Pneumatization from the anterior ethmoid sinus can invade adjacent osseous structures and form paranasal sinus cells. This includes the middle nasal turbinate, with the resultant cell known as a concha bullosa. (1)

A 31-year-old man presented with nasal obstruction of many years' duration. He had tried numerous medications over several years without any significant relief. A nasal endoscopic exam and computed tomography (CT) (figure, A) revealed a large, obstructing left concha bullosa, a smaller right concha bullosa, and a nasal septum shifted into the right airway. The patient elected to undergo nasal septal reconstruction and powered partial resection of the left concha bullosa.

At the time of surgery, the left concha bullosa was entered anteriorly (figure, B) and the lateral portion of the concha bullosa was resected. A drainage pathway could be seen in the posterolateral portion of the concha bullosa (figure, C and D), which appeared to empty into the left middle meatus.

A concha bullosa of the middle turbinate most commonly drains into the anterior ethmoid sinus. (2) Drainage of the concha bullosa has been described to occur medially into the nasal cavity (3) or laterally into the middle meatus. (4) A concha bullosa is a normal anatomic variant. It does not require surgical intervention unless it creates obstructive problems with respiration or functional drainage problems for the middle meatus and the paranasal sinuses. Anatomic obstruction often can be relieved with partial removal of the middle turbinate with preservation of a significant portion of its structure.

References

(1.) Hollinshead WH. Anatomy for Surgeons. Volume 1: The Head and Neck. 3rd ed. Philadelphia: Harper and Row; 1982: 254.

(2.) Stammberger H. Functional Endoscopic Sinus Surgery: The Messerklinger Technique. Philadelphia: B.C. Decker; 1991:1-529.

(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 J 2003;82(3): 159-60. Eiji Yanagisawa, MD, FACS; Deway A. Christmas, MD: Joseph P. Mirante, MD, MBA, FACS

From the Section of Otolaryngology, Yale New Haven Hospital-St. Raphael Campus, and the Yale University School of Medicine, New Haven, Ct. (Dr. Yanagisawa); the Department of Otolaryngology, the Halifax Medical Center, Daytona Beach, Fla. (Dr. Christmas and Dr. Mirante); and Florida State University School of Medicine, Daytona Beach (Dr. Mirante).

Caption: Figure. A: CT scan of a left concha bullosa shows a drainage pathway. B: The anterior left concha bullosa is entered with a microdebrider. C: A pathway is seen in the concha bullosa leading posterolaterally. D: This is a closer view of the posterolateral drainage pathway of the concha bullosa.

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Title Annotation:RHINOSCOPIC CLINIC
Author:Yanagisawa, Eiji; Christmas, Dewey A.; Mirante, Joseph P.
Publication:Ear, Nose and Throat Journal
Article Type:Case study
Geographic Code:1USA
Date:Oct 1, 2017
Words:454
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