Citation, DOI & article data
Concha bullosa (plural: conchae bullosae) (also known as middle turbinate pneumatization) is a common finding and although associated with deviation of the nasal septum, it is usually of little clinical importance.
Concha bullosa is a normal variant and is one of the most common variations of sinonasal anatomy, it is identified in ~35% (range 14-53%) of patients 1. The wide range of prevalence is attributable to variability in the definition used for the diagnosis (see below).
In the vast majority of cases, these variants are asymptomatic. Although some studies have suggested a relationship between a concha bullosa and sinus disease, it is probably not the case, with the incidence of sinusitis being similar in patients with or without a concha 1. The air space within the turbinate is susceptible to the same pathologies as other sinuses, and may thus become infected, obstructed (mucocele), or be the site of malignancy.
Conchae bullosae are associated with deviation of the nasal septum (see below) which has itself been in some studies associated with an increase incidence of sinus disease 1,5.
Concha bullosa of the middle turbinate can be divided into one of three types:
- lamellar: pneumatization of the vertical lamella of the concha (many authors do not regard this as a concha bullosa) 1
- bulbous: pneumatization of the bulbous segment
- extensive (total): pneumatization of both lamellar and bulbous parts
They are associated with deviation of the nasal septum away from the concha bullosa, with preserved surrounding air spaces (suggesting developmental asymmetry rather than mass effect)
It is worth noting that a concha bullosa and a deviated septum may interfere with transnasal surgery and is thus a relevant finding on imaging of the region for other reasons 6.
Treatment and prognosis
As most are asymptomatic and the relationship between a concha bullosa and sinusitis is controversial, in general, no treatment is required.
If infected or large and associated with ipsilateral maxillary sinus obstruction resection may be undertaken, in which case the lateral wall of the concha is resected, leaving the medial wall intact to maintain the middle turbinate 6.
- 1. Stallman JS, Lobo JN, Som PM. The incidence of concha bullosa and its relationship to nasal septal deviation and paranasal sinus disease. AJNR Am J Neuroradiol. 2004;25 (9): 1613-8. AJNR Am J Neuroradiol (full text) - Pubmed citation
- 2. Hatipoğlu HG, Cetin MA, Yüksel E. Concha bullosa types: their relationship with sinusitis, ostiomeatal and frontal recess disease. Diagn Interv Radiol. 2005;11 (3): 145-9. Diagn Interv Radiol (link) - Pubmed citation
- 3. Zinreich S, Albayram S, Benson M, Oliverio P. The ostiomeatal complex and functional endoscopic surgery. Head and Neck Imaging. 4th ed.: Mosby 2003; 149-173
- 4. Stammberger H, Kopp W, Hasler G. Functional endoscopic sinus surgery, the Messerklinger technique. Mosby Inc. (1991) ISBN:0941158969. Read it at Google Books - Find it at Amazon
- 5. Elahi MM, Frenkiel S, Fageeh N. Paraseptal structural changes and chronic sinus disease in relation to the deviated septum. J Otolaryngol. 1997;26 (4): 236-40. - Pubmed citation
- 6. Snow JB, Wackym PA. Ballenger's otorhinolaryngology, head and neck surgery. Pmph-usa. (2009) ISBN:1550093371. Read it at Google Books - Find it at Amazon
- 7. Smith KD, Edwards PC, Saini TS et-al. The prevalence of concha bullosa and nasal septal deviation and their relationship to maxillary sinusitis by volumetric tomography. Int J Dent. 2010;2010 doi:10.1155/2010/404982 - Free text at pubmed - Pubmed citation