Concha bullosa in otorhinolaryngologist’s practice

Karpishchenko S.A.; Lavrenova G.V.; Oganyan K.A.

doi:https://doi.org/10.17116/rosrino202331031206

Close metadata

Abstract:

Middle nasal concha is a significant anatomic landmark for surgical interventions on nasal cavity and paranasal sinuses. Knowledge of anatomical variants, understanding of the processes of tissue structure formation in this important functional area are necessary for safe endoscopic surgery.

OBJECTIVE

To summarize data about prevalence, anatomical topography features and clinical manifestations of pneumatized middle nasal concha.

MATERIAL AND METHODS

The materials of scientific publications, presented in the RSCI, Medline and PubMed databases were used as a data source. The choice of materials was carried out by the keywords: concha bullosa, embryology of nasal cavity, variants of middle nasal concha development, modern classifications.

RESULTS AND CONCLUSION

The main anatomical variants of middle nasal conchae pneumatization were described, the most common of them is concha bullosa (CB). CB is usually asymptomatic, but in cases of extensive pneumatization, a large concha bullosa can cause clinical manifestations. The most common symptoms in the presence of extensive pneumatization of middle concha are nasal congestion and facial pain. The modern classifications of CB are given. The significance of middle concha pneumatization in endoscopic rhinosurgery is shown.

Keywords:

concha bullosa

embryology of nasal cavity

variants of middle nasal conchae development

modern classifications

Authors:

Karpishchenko S.A.

Pavlov First St. Petersburg State Medical University

ORCID: 0000-0003-1124-1937

Lavrenova G.V.

I.P. Pavlov First Saint Petersburg State Medical University

ORCID: 0000-0002-3537-0226

Oganyan K.A.

I.P. Pavlov First Saint Petersburg State Medical University

ORCID: 0000-0002-4138-2127

Received:

13.02.2023

Accepted:

22.03.2023

Close metadata

References:

Fidan V. Panconcha bullosa: new definition in the literature. J Craniofac Surg. 2012;23(3):253-254. https://doi.org/10.1097/SCS.0b013e31825186b6
Lee HY, Kim CH, Kim JY, Kim JK, Song MH, Yang HJ, Kim KS, Chung IH, Lee JG, Yoon JH. Surgical anatomy of the middle turbinate. Clin Anat. 2006;19(6):493-496. https://doi.org/10.1002/ca.20202
İla K, Yilmaz N, Öner S, Başaran E, Öner Z. Evaluation of superior concha bullosa by computed tomography. Surg Radiol Anat. 2018;40(7):841-846. https://doi.org/10.1007/s00276-018-2010-8
Piskunov GZ. Physiological and pathophysiological basis for functional endoscopic sinus surgery. Folia Otorhinolaryngologiae et Pathologiae Respiratoriae. 2018;24(1):23-28. (In Russ.).
Karpishchenko SA, Bolozneva YeV, Stancheva OA, Golubev AYu. Clinical and Anatomical Features of the Middle Turbinate Affecting the Course of Chronic Sinusitis. Effective pharmacotherapy. 2019;15(30):26-28. (In Russ.). https://doi.org/10.33978/2307-3586-2019-15-30-26-28
Kantarci M, Karasen RM, Alper F, Onbas O, Okur A, Karaman A. Remarkable anatomic variations in paranasal sinus region and their clinical importance. Eur J Radiol. 2004;50(3):296-302. https://doi.org/10.1016/j.ejrad.2003.08.012
Santorinus DJ. Observationes anatomicae. In: Braun H, Stammberger H. Pneumatization of turbinates. Laryngoscope. 2003;113:668-672. https://doi.org/10.1097/00005537-200304000-00016
Zinreich SJ, Mattox DE, Kennedy DW, Chisholm HL, Diffley DM, Rosenbaum AE. Concha bullosa: CT evaluation. J Comput Assist Tomogr. 1988; 12(5):778-784. https://doi.org/10.1097/00004728-198809010-00012
Bolger WE, Butzin CA, Parsons DS. Paranasal sinus bony anatomic variations and mucosal abnormalities: CT analysis for endoscopic sinus surgery. Laryngoscope. 1991;101(1 Pt 1):56-64. https://doi.org/10.1288/00005537-199101000-00010
Piskunov IS, Boiko NV, Kolesnikov VN. The peculiar features of the anatomical structure of the inferior turbinated bone. Russian Rhinology. 2017; 25(3):10-15. (In Russ.). https://doi.org/10.17116/rosrino201725310-15
Acikalin RM, Bayram O, Haci C, Yanik HT, Ozturkcu Y, Kocak A, Insan A. Is there a relationship between middle concha bullosa and ethmoid roof asymmetry? Braz J Otorhinolaryngol. 2022;88(1):101-104. https://doi.org/10.1016/j.bjorl.2020.06.003
Bolger WE, Butzin CA, Parsons DS. Paranasal sinus bony anatomic variations and mucosal abnormalities: CT analysis for endoscopic sinus surgery. Laryngoscope. 1991;101(1 Pt 1):56-64. https://doi.org/10.1007/978-3-540-74380-4_2
Braun H, Stammberger H. Pneumatization of turbinates. Laryngoscope. 2003;113(4):668-672. https://doi.org/10.1097/00005537-200304000-00016
Bolger WE. Anatomy of paranasal sinuses. In: Kennedy DW, Bolger WE, Zinreich SJ. Diseases of the sinuses. London, UK: BC Decker Inc.; 2001. https://doi.org/10.1007/978-3-540-74380-4_2
Neskey D, Eloy JA, Casiano RR. Nasal, septal, and turbinate anatomy and embryology. Otolaryngol Clin North Am. 2009;42(2):193-205. https://doi.org/10.1016/j.otc.2009.01.008
Stammberger H, Posawetz W. Functional endoscopic sinus surgery. Eur Arch Otorhinolaryngol. 1990;247:63-76. https://doi.org/10.1007/BF00183169
Lund VJ, Stammberger H, Fokkens WJ, Beale T, Bernal-Sprekelsen M, Eloy P, Georgalas C, Gerstenberger C, Hellings PW, Herman P, Hosemann WG, Jankowski R, Jones N, Jorissen M, Leunig A, Onerci M, Rimmer J, Rombaux P, Simmen D, Tomazic PV, Tschabitscher M, Welge-Luessen A. European Position Paper on the Anatomical Terminology of the Internal Nose and Paranasal Sinuses. Rhinology. 2014;24:1-34.
Uzun L, Aslan G, Mahmutyazicioglu K, Yazgan H, Savranlar A. Is pneumatization of middle turbinates compensatory or congenital? Dentomaxillofac Radiol. 2012;41(7):564-570. https://doi.org/10.1259/dmfr/31644208
Samoliński BK, Grzanka A, Gotlib T. Changes in nasal cavity dimensions in children and adults by gender and age. Laryngoscope. 2007;117(8):1429-1433. https://doi.org/10.1097/MLG.0b013e318064e837
Odat H, Al-Qudah M. Concha Bullosa and Ethmoid Structures Pneumatization: The Effect of Altitude and Other Variables. J Craniofac Surg. 2016; 27(7):667-669. https://doi.org/10.1097/SCS.0000000000003035
Dogru H, Doner F, Uygur K, Gedikli O, Cetin M. Pneumatized inferior turbinate. Am J Otolaryngol. 1999;20:139-141. https://doi.org/10.1016/S0196-0709(99)90024-8
Toplu Y, Bayindir T, Karatas E, Akarcay M. All concha bullosa: an undefined abnormality of the lateral nasal wall. Indian J Otolaryngol Head Neck Surg. 2013;65(1):86-88. https://doi.org/10.1007/s12070-012-0592-8
Calhoun KH, Waggenspack GA, Simpson CB, Hokanson JA, Bailey BJ. CT evaluation of the paranasal sinuses in symptomatic and asymptomatic populations. Otolaryngol Head Neck Surg. 1991;104(4):480-483. https://doi.org/10.1177/019459989110400409
Unlü HH, Akyar S, Caylan R, Nalça Y. Concha bullosa. J Otolaryngol. 1994;23(1):23-27.
Uygur K, Tüz M, Doğru H. The correlation between septal deviation and concha bullosa. Otolaryngol Head Neck Surg. 2003;129(1):33-36. https://doi.org/10.1016/S0194-59980300479-0
Chaiyasate S, Baron I, Clement P. Analysis of paranasal sinus development and anatomical variations: a CT genetic study in twins. Clin Otolaryngol. 2007;32:93-97. https://doi.org/10.1111/j.1365-2273.2007.01404.x
Stammberger H. Endoscopic and radiologic diagnosis. In: Stammberger H. Functional Endoscopic Sinus Surgery: The Messerklinger Technique. 1st ed. Philadelphia, PA: BC Decker; 1991.
Uygur K, Tüz M, Doğru H. The correlation between septal deviation and concha bullosa. Otolaryngol Head Neck Surg. 2003;129(1):33-36. https://doi.org/10.1016/S0194-59980300479-0
Calvo-Henríquez C, Ruano-Ravina A, Martinez-Capoccioni G, Huaranca M, Lattomus K, Martin-Martin C. The lamellar cell: a radiological study and a new classification proposal. Eur Arch Otorhinolaryngol. 2018;275(11): 2713-2717. https://doi.org/10.1007/s00405-018-5111-4
Moukarzel N, Nehmé A, Mansour S, Yammine FG, Moukheiber A. Middle turbinate medialization technique in functional endoscopic sinus surgery. J Otolaryngol. 2000;29(3):144-147.
Grunwald L. (1925) Anatomie und Entwicklungsgeschichte. Die Krankheiten der Luftwege und Mundhöhle. 1st edn. Berlin: Springer; 1925.
Calvo-Henriquez C, Mayo-Yañez M, Chiesa-Estomba CM, Martinez-Capoccioni G, Martin-Martin C. Relationship between the Superior Attachment of the Uncinate Process and Pneumatization of the Middle Turbinate — A Radiological Study. Surgeries. 2022;3:134-141. https://doi.org/10.3390/surgeries3020015
Landsberg R, Friedman M. A computer-assisted anatomical study of the nasofrontal region. Laryngoscope. 2001;111(12):2125-2130. https://doi.org/10.1097/00005537-200112000-00008
Mahmutoğlu AS, Çelebi I, Akdana B, Bankaoğlu M, Çakmakçi E, Çelikoyar MM, Başak M. Computed tomographic analysis of frontal sinus drainage pathway variations and frontal rhinosinusitis. J Craniofac Surg. 2015; 26(1):87-90. https://doi.org/10.1097/SCS.0000000000001244
Turgut S, Ercan I, Sayin I, Başak M. The relationship between frontal sinusitis and localization of the frontal sinus outflow tract: a computer-assisted anatomical and clinical study. Arch Otolaryngol Head Neck Surg. 2005;131(6): 518-522. https://doi.org/10.1001/archotol.131.6.518
Badran HS. Role of surgery in isolated concha bullosa. Clin Med Insights Ear Nose Throat. 2011;4:13-19. https://doi.org/10.4137/CMENT.S6769
Zinreich SJ, Mattox DE, Kennedy DW, Chisholm HL, Diffley DM, Rosenbaum AE. Concha bullosa: CT evaluation. J Comput Assist Tomogr. 1988; 12(5):778-784. https://doi.org/10.1097/00004728-198809010-00012
Toledano A, Herráiz C, Mate A, Plaza G, Aparicio JM, De Los Santos G, Galindo AN. Mucocele of the middle turbinate: a case report. Otolaryngol Head Neck Surg. 2002;126(4):442-444. https://doi.org/10.1067/mhn.2002.123346
Badia L, Parikh A, Brookes GB. Pyocele of the middle turbinate. J Laryngol Otol. 1994;108(9):783-784. https://doi.org/10.1017/s0022215100128117
Shihada R, Luntz M. A concha bullosa mucopyocele manifesting as migraine headaches: a case report and literature review. Ear Nose Throat J. 2012; 91(5):16-18. https://doi.org/10.1177/014556131209100518