The site of the Media Sphera Publishers contains materials intended solely for healthcare professionals.
By closing this message, you confirm that you are a certified medical professional or a student of a medical educational institution.

Malysheva O.E.

OOO «Novaya Klinika «ABIA»

Klimenko K.E.

Central State Medical Academy of the Administrative Directorate of the President of the Russian Federation;
Central Clinical Hospital with Polyclinic of the Administrative Directorate of the President of the Russian Federation

Rusetskiy Yu.Yu.

Central State Medical Academy of the Administrative Directorate of the President of the Russian Federation;
Central Clinical Hospital with Polyclinic of the Administrative Directorate of the President of the Russian Federation

Lebedeva A.A.

Central State Medical Academy of the Administrative Directorate of the President of the Russian Federation

Middle nasal concha: anatomical variants and surgical correction methods

Authors:

Malysheva O.E., Klimenko K.E., Rusetskiy Yu.Yu., Lebedeva A.A.

More about the authors

Journal: Russian Rhinology. 2025;33(3): 233‑241

Read: 181 times


To cite this article:

Malysheva OE, Klimenko KE, Rusetskiy YuYu, Lebedeva AA. Middle nasal concha: anatomical variants and surgical correction methods. Russian Rhinology. 2025;33(3):233‑241. (In Russ.)
https://doi.org/10.17116/rosrino202533031233

Recommended articles:

References:

  1. Nechaev VA. Kompyuternaya tomografiya okolonosovykh pazukh v planirovanii funktsional’noi endoskopicheskoi khirurgii i preduprezhdenii posleoperatsionnykh oslozhnenii (illyustrirovannyi obzor). Radiologiya ‒ praktika. 2022;6:47-59 (In Russ.). https://doi.org/10.52560/2713-0118-2022-6-47-59
  2. Mirzabaev DE, Barankulova MM, Aitzhanova B. Endoskopicheskaya rinosinusokhirurgiya — novye tekhnologii, novye gorizonty (obzor literatury). Vestnik KazNMU. 2015;2:140-142. (In Russ.).
  3. Ikromov MK, Davlatov DSh, Nazirmadova MB, Abdukhalilov AA. Otsenka effektivnosti endoskopicheskoi sinusotomii pri khronicheskikh polipoznykh rinosinusitakh po dannym lor kliniki GU «Natsional’nyi meditsinskii tsentr» RT. Vestnik Avitsenny. 2017;19(1):63-67. (In Russ.).
  4. Piskunov GZ, Piskunov SZ, Kozlov VS, Lopatin AS. Zabolevaniya nosa i okolonosovykh pazukh: endomikrokhirurgiya. Moskva: Kollektsya «Sovershenno sekretno»; 2003. (In Russ.).
  5. Chiu AG, Palmer DN, Adappy ND. Atlas endoskopicheskoi khirurgii okolonosovykh pazukh i osnovaniya cherepa. Perevod s angliiskogo pod red. S.Ya. Kosyakova. Moskva: GEOTAR-Media; 2023. (In Russ.).
  6. Vormald PD. Endoskopicheskaya rinosinusokhirurgiya. Anatomiya, obemnaya rekonstruktsiya i khirurgicheskaya tekhnika. Perevod s angliiskogo pod red. K.E. Klimenko. 2021. Moskva: Medicinskaya literatura; 2021. (In Russ.).
  7. Stępiński MJ, Banaszewski J. Intranasal Synechiae as Complications of Rhinosurgical Treatment ‒ A Review of Current Knowledge. J Clin Med. 2023;12(21):1-12.  https://doi.org/10.3390/jcm12216831
  8. Nosulya EV, Kim IA, Maksimova VA, Chernykh NM, Kravchuk AP. Chastota i varianty pnevmatizatsii vnutrinosovykh struktur i ikh svyaz s khronicheskim sinusitom. Russian Rhinology. 2021;29(3):155-160. (In Russ.). https://doi.org/10.17116/rosrino202129031155
  9. Suratwala SB, Suratwala JN, Jadawala HD. Effectiveness of Volumetric Reduction of Middle Concha Bullosa by Crushing Technique in Chronic Nasal Obstruction. Indian J Otolaryngol Head Neck Surg. 2022;74(2):1009-1016. https://doi.org/10.1007/s12070-020-02047-w
  10. Al-Kholaiwi FM, Al-Khatabi RA, Al-Shehri GA, Al-Ghonaim YA. Giant concha bullosa presented as left nasal mass: a case report and literature review. J Surg Case Rep. 2023;2023(10):558.  https://doi.org/10.1093/jscr/rjad558
  11. İsmi O, Meşe F, Gür H, Gürses İ, Vayısoğlu Y, Görür K, Özcan C. Olfactory neuroepithelium in the middle turbinate: is there any impact on olfaction function after lateral marsupialization for concha bullosa surgery? Brazilian J of Otorhinolaryngology. 2022;88(5):12-18.  https://doi.org/10.1016/j.bjorl.2021.06.005
  12. Cellina M, Gibelli D, Cappella A, Martinenghi C, Belloni E, Oliva G. Nasal cavities and the nasal septum: Anatomical variants and assessment of features with computed tomography. Neuroradiol J. 2020;33(4):340-347.  https://doi.org/10.1177/1971400920913763
  13. Bolger WE, Butzin CA, Parsons DS. Paranasal sinus bony anatomic variations and mucosal abnormalities: CT analysis for endoscopic sinus surgery. Laryngoscope. 1991;101(1):56-64.  https://doi.org/10.1288/00005537-199101000-00010
  14. Karpishchenko SA, Bolozneva EV, Golubev AYu, Kozyreva EE. Influence of shape of middle turbinate on development of recurrent rhinosinusitis. Rossiiskaya otorinolaringologiya. 2021;20(3):108-114. (In Russ.). https://doi.org/10.18692/1810-4800-2021-3-108-114
  15. Piskunov VS, Mezentseva OYu. Funtcional and morphological changes in nasal mucosa in patients presenting with septal deformation. Russian Bulletin of Otorhinolaryngology. 2011:(1):13-15. (In Russ.).
  16. Piskunov GZ, Piskunov SZ. Klinicheskaya rinologiya. Rukovodstvo dlya vrachei. Moskva: MIA; 2006. (In Russ.).
  17. 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
  18. Demir D, Asil K, Güven M, Kayabaşoğlu G, Yılmaz MS. Assessment of the correlation between nasal septal deviation and compensatory hypertrophy of the middle turbinate. Eur Arch Otorhinolaryngol. 2015;272(10):2847-2851. https://doi.org/10.1007/s00405-014-3387-6
  19. Demir D, Asil K, Güven M, Erkorkmaz Ü. Does septoplasty change the dimensions of compensatory hypertrophy of the middle turbinate? J Laryngol Otol. 2016;130(6):554-559.  https://doi.org/10.1017/s0022215116001055
  20. Kryukov AI, Kunelskaya NL, Turovski AB, Kravchenko DV. Lechebno-diagnosticheskii algoritm pri orbitalnykh rinosinusogennykh oslozhneniyakh lor organov. GUZ «Moskovskii nauchno-prakticheskii tsentr otorinolaringologii» Departamenta zdravookhraneniya goroda Moskvy. Accessed July 09, 2025 (In Russ.). https://nikio.ru/%D0%BB%D0%B5%D1%87%D0%B5%D0%B1%D0%BD%D0%BE-%D0%B4%D0%B8%D0%B0%D0%B3%D0%BD%D0%BE%D1%81%D1%82%D0%B8%D1%87%D0%B5%D1%81%D0%BA%D0%B8%D0%B9-%D0%B0%D0%BB%D0%B3%D0%BE%D1%80%D0%B8%D1%82%D0%BC
  21. Stammberger H. Nasal and paranasal sinus endoscopy. A diagnostic and surgical approach to recurrent sinusitis. Endoscopy. 1986;18(6):213-218.  https://doi.org/10.1055/s-2007-1018382
  22. Stammberger H. Personal endoscopic operative technic for the lateral nasal wall--an endoscopic surgery concept in the treatment of inflammatory diseases of the paranasal sinuses. Laryngol Rhinol Otol (Stuttg). 1985;64(11):559-566. 
  23. Stammberger H, Posawetz W. Functional endoscopic sinus surgery. Concept, indications and results of the Messerklinger technique. Eur Arch Otorhinolaryngol. 1990;247(2):63-76.  https://doi.org/10.1007/bf00183169
  24. Stammberger H, Zinreich SJ, Kopp W, Kennedy DW, Johns ME, Rosenbaum AE. Surgical treatment of chronic recurrent sinusitis--the Caldwell-Luc versus a functional endoscopic technic. HNO. 1987;35(3):93-105. 
  25. Vigand ME, Iro Kh. Endoskopicheskaya khirurgiya okolonosovykh pazukh i perednego otdela osnovaniya cherepa. Moskva: Meditsinskaya literatura; 2010. (In Russ.).
  26. Wigand ME, Steiner W, Jaumann MP. Endonasal sinus surgery with endoscopical control: from radical operation to rehabilitation of the mucosa. Endoscopy. 1978;10(4):255-260.  https://doi.org/10.1055/s-0028-1098304
  27. Wigand ME. Transnasal ethmoidectomy under endoscopical control. Rhinology. 1981;19(1):7-15. 
  28. Wigand ME, Hosemann W. Microsurgical treatment of recurrent nasal polyposis. Rhinol Suppl. 1989;8:25-29. 
  29. Wigand ME. Transnasal, endoscopical sinus surgery for chronic sinusitis. I. A biomechanical concept of the endonasal mucosa surgery. HNO. 1981; 29(7):215-221. 
  30. Freedman HM, Kern E.B. Complications of intranasal ethmoidectomy: a review of 1,000 consecutive operations. Laryngoscope. 1979;89(3):421-434.  https://doi.org/10.1288/00005537-197903000-00010
  31. Lawson W. The intranasal ethmoidectomy: an experience with 1,077 procedures. Laryngoscope. 1991;101(4 Pt 1):367-371.  https://doi.org/10.1002/lary.1991.101.4.367
  32. Havas TE, Lowinger DS. Comparison of functional endonasal sinus surgery with and without partial middle turbinate resection. Ann Otol Rhinol Laryngol. 2000;109(7):634-640.  https://doi.org/10.1177/000348940010900704
  33. Anchan SV, Shah V, Jalisatgi RR, Naik AS, Sidappa R, Pandurangi AS. A Comparative Study of Interventions of Middle Turbinate Medialization in Endoscopic Sinus Surgery. Indian J Otolaryngol Head Neck Surg. 2022; 74(2):1706-1712. https://doi.org/10.1007/s12070-021-02861-w
  34. Murali S, Vijayaraj GP, Saravanam PK, Thattarakkal VR. Partial middle turbinectomy versus medialization suturing of middle turbinate in the management of sinonasal polyposis: a comparative study. Indian J Otolaryngol Head Neck Surg. 2022;74(2):1472-1478. https://doi.org/10.1007/s12070-021-02609-6
  35. Klimenko KE, Rusetsky YuYu, Kudryashov SE, Kryukov AI, Tovmasyan AS. Long-term results of extended endoscopic interventions in severe forms of chronic frontal sinusitis. Russian Rhinology. 2022;30(2):72-78. (In Russ.). https://doi.org/10.17116/rosrino20223002172
  36. Bofares KM. Effect of middle turbinate intervention on outcomes of middle meatal endoscopic surgery. Pan Arab J Rhinol. 2016;06:27-32.  https://doi.org/10.4103/2090-7540.186905
  37. Toffel PH. Secure endoscopic sinus surgery with partial middle turbinate modification: a 16 y1ear long-term outcome report and literature review. Curr Opin Otolaryngol Head Neck Surg. 2003;11(1):13-18.  https://doi.org/10.1097/00020840-200302000-00003
  38. Kaluskar SK. Wedge Resection of the Middle Turbinate—An Adjunct to Functional Endoscopic Sinus Surgery (FESS). Indian J Otolaryngol Head Neck Surg. 1998;50(1):106-108.  https://doi.org/10.1007/bf02996791
  39. El-Banhawy OA, El-Dien Ael-H, Zolfakar AS, Halaka AN, Ayad H. Endoscopic Endonasal Partial Middle Turbinectomy Approach: Adaptability of the Procedure in a Cadaveric Study and in Surgery for Different Sphenoid Sinus and Skull Base Lesions. Skull Base. 2006;16(1):1-13.  https://doi.org/10.1055/s-2005-922014
  40. Kim MH, Richard RO. Suture medialization of the middle turbinates during endoscopic sinus surgery. Ear Nose Throat J. 2008;87(12):11. 
  41. Chen W, Wang Y, Bi Y, Chen W. Turbinate-septal suture for middle turbinate medialization: a prospective randomized trial. Laryngoscope. 2015; 125(1):33-35.  https://doi.org/10.1002/lary.24820
  42. Lindemann J, Keck T, Rettinger G. Septal-turbinate-suture in endonasal sinus surgery. Rhinology. 2002;40(2):92-94. 
  43. Thornton RS. Middle turbinate stabilization technique in endoscopic sinus surgery. Arch Otolaryngol Head Neck Surg. 1996;122(8):869-872.  https://doi.org/10.1001/archotol.1996.01890200059013
  44. Dutton JM, Hinton MJ. Middle turbinate suture conchopexy during endoscopic sinus surgery does not impair olfaction. Am J Rhinol Allergy. 2011; 25(2):125-127.  https://doi.org/10.2500/ajra.2011.25.3560
  45. Hewitt KM, Orlandi RR. Suture medialisation of the middle turbinate during endoscopic sinus surgery. Ear Nose Throat J. 2008;87(12):11. 
  46. Koch T. Medialisierung und Fixierung der mittleren Nasenmuschel bei der endonasalen Siebbeinoperation. Laryngorhinootologie. 2008;87(1):6-9. 
  47. Alaryani RA, Alhedaithy RA. Preventive Measures of Middle Turbinate Lateralization After Endoscopic Sinus Surgery: An Updated Review. Cureus. 2021;19;13(6):e15763. https://doi.org/10.7759/cureus.15763
  48. Weber RK, Hosemann W. Comprehensive review on endonasal endoscopic sinus surgery. GMS Curr Top Otorhinolaryngol Head Neck Surg. 2015;22:14.  https://doi.org/10.3205/cto000123
  49. Bolger WE, Kuhn FA, Kennedy DW. Middle turbinate stabilization after functional endoscopic sinus surgery: the controlled synechiae technique. Laryngoscope. 1999;109(11):1852-1853. https://doi.org/10.1097/00005537-199911000-00025
  50. Friedman M, Landsberg R, Tanyeri H. Middle turbinate medialisation and preservation in endoscopic sinus surgery. Otolaryngol Head Neck Surg. 2000; 123(1):76-80.  https://doi.org/10.1067/mhn.2000.105921
  51. Bansal C, Singh VP. Management of Unstable Middle Turbinate in Endoscopic Sinus Surgery. Indian J Otolaryngol Head Neck Surg. 2019;71(3):1940-1943. https://doi.org/10.1007%2Fs12070-018-1353-0
  52. Wong E, Singh N. An Improved Method for Temporary Suture Medialisation of the Middle Turbinates following Endoscopic Sinus Surgery. Int J Otolaryngol. 2018;12:9093545. https://doi.org/10.1155/2018/9093545
  53. Banfield GK, Combe AM. Partial resection of the middle turbinate at functional endoscopic sinus surgery. J R Army Med Corps. 1999;145(1):18-19.  https://doi.org/10.1136/jramc-145-01-05
  54. Andaloro C, La Mantia I, Castro V, Grillo C. Comparison of nasal and olfactory functions between two surgical approaches for the treatment of concha bullosa: a randomized clinical trial. J Laryngol Otol. 2019;133(10):913-917.  https://doi.org/10.1017/s0022215119001968
  55. LaMear WR, Davis WE, Templer JW, McKinsey JP, Del Porto H. Partial endoscopic middle turbinectomy augmenting functional endoscopic sinus surgery. Otolaryngol Head Neck Surg. 1992 Sep;107(3):382-389. 
  56. Shih C, Chin G, Rice DH. Middle turbinate resection: impact on outcomes in endoscopic sinus surgery. Ear Nose Throat J. 2003;82(10):796-797.  https://doi.org/10.1177/014556130308201013
  57. Zhao K, Malhotra P, Rosen D, Dalton P, Pribitkin EA. Computational fluid dynamics as surgical planning tool: a pilot study on middle turbinate resection. Anat Rec (Hoboken). 2014;297(11):2187-2195. https://doi.org/10.1002/ar.23033
  58. Fortune DS, Duncavage JA. Incidence of frontal sinusitis following partial middle turbinectomy. Ann Otol Rhinol Laryngol. 1998;107(6):447-453.  https://doi.org/10.1177/000348949810700601
  59. Roy M, Lade H. Functional Endoscopic Sinus Surgery of Nasal Polyposis: The Vexing Question of Whether to Resect or Preserve Middle Turbinate. Indian J Otolaryngol Head Neck Surg. 2019;71(3):2025-2030. https://doi.org/10.1007/s12070-018-1450-0
  60. Mariano FC, Hamerschmidt R, Soares CMC, Moreira AT. The Middle Turbinate Resection and Its Repercussion in Olfaction with the University of Pennsylvania Smell Identification Test (UPSIT). Int Arch Otorhinolaryngol. 2018;22(3):280-283.  https://doi.org/10.1055/s-0037-1608679
  61. Swanson P, Lanza DC, Kennedy DW, Vining EM. The effect of middle turbinate resection upon frontal sinus disease. American Journal of Rhinology. 1995;9:191-195.  https://doi.org/10.2500/105065895781873737
  62. Pinther S, Deeb R, Peterson EL, Standring RT, Craig JR. Complications are rare from middle turbinate resection: a prospective case series. Am J Rhinol Allergy. 2019;33(6):657-664.  https://doi.org/10.1177/1945892419860299
  63. Miller AJ, Bobian M, Peterson E, Deeb R. Bleeding risk associated with resection of the middle turbinate during functional endoscopic sinus surgery. Am J Rhinol Allergy. 2016;30(2):140-142.  https://doi.org/10.2500/ajra.2016.30.4273
  64. Kennedy DW. Middle turbinate resection: Evaluating the issues––should we resect normal middle turbinates? Arch Otolaryngol Head Neck Surg. 1998;124(1):107.  https://doi.org/10.1001/archotol.124.1.107
  65. Saidi IS, Biedlingmaier JF, Rothman MI. Pre- and postoperative imaging analysis for frontal sinus disease following conservative partial middle turbinate resection. Ear Nose Throat J. 1998;77(4):326-328. 
  66. Alam S, Li C, Bradburn KH, Zhao K, Lee TS. Impact of Middle Turbinectomy on Airflow to the Olfactory Cleft: A Computational Fluid Dynamics Study. Am J Rhinol Allergy. 2019;33(3):263-268.  https://doi.org/10.1177/1945892418816841
  67. Hudon MA, Wright ED, Fortin-Pellerin E, Bussieres M. Resection versus preservation of the middle turbinate in surgery for chronic rhinosinusitis with nasal polyposis: a randomized controlled trial. J Otolaryngol Head Neck Surg. 2018;47(1):67.  https://doi.org/10.1186/s40463-018-0313-8
  68. Ziegler A, Patadia M, Patel C. Current practices regarding middle turbinate resection among otolaryngologists. World J Otorhinolaryngol Head Neck Surg. 2023;9(2):183-188.  https://doi.org/10.1002/wjo2.84
  69. Soler ZM, Hwang PH, Mace J, Smith TL. Outcomes after Middle Turbinate Resection: Revisiting a Controversial Topic. Laryngoscope. 2010; 120(4):832-837.  https://doi.org/10.1002/lary.20812
  70. Jang DW, Lachanas VA, Segel J, Kountakis SE. Budesonide nasal irrigations in the postoperative management of chronic rhinosinusitis. Int Forum Allergy Rhinol. 2013;3(9):708-711.  https://doi.org/10.1002/alr.21189
  71. Wu AW, Ting JY, Platt MP, Tierney HT, Metson R. Factors affecting time to revision sinus surgery for nasal polyps: a 25-year experience. Laryngoscope. 2014;124(1):29-33.  https://doi.org/10.1002/lary.24213
  72. Marchioni D, Alicandri-Ciufelli M, Mattioli F, Marchetti A, Jovic G, Massone F, Presutti L. Middle turbinate preservation versus middle turbinate resection in endoscopic surgical treatment of nasal polyposis. Acta Otolaryngol. 2008;128(9):1019-1026. https://doi.org/10.1080/00016480701827541
  73. Kuhn FA, Citardi MJ. Advances in postoperative care following functional endoscopic sinus surgery. Otolaryngol Clin North Am. 1997;30(3):479-490. 
  74. Tanyeri H, Aksoy EA, Serin GM, Polat S, Türk A, Unal OF.Will a crushed concha bullosa form again? Laryngoscope. 2012;122(5):956-960.  https://doi.org/10.1002/lary.23234
  75. Kieff DA, Busaba NY. Reformation of concha bullosa following treatment by crushing surgical technique: implication for balloon sinuplasty. Laryngoscope. 2009;119(12):2454-2456. https://doi.org/10.1002/lary.20640
  76. Vobilisetty RK, Tiwari D. Comparative Study Between Crushing Technique and Lateral Laminectomy of Middle Turbinate as Auxiliary Management in Patients Who Underwent Septoplasty with Concha Bullosa. Indian J Otolaryngol Head Neck Surg. 2022;74(2):1153-1156. https://doi.org/10.1007/s12070-020-02222-z

Email Confirmation

An email was sent to test@gmail.com with a confirmation link. Follow the link from the letter to complete the registration on the site.

Email Confirmation

We use cооkies to improve the performance of the site. By staying on our site, you agree to the terms of use of cооkies. To view our Privacy and Cookie Policy, please. click here.