Concha bullosa
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At the time the article was created Daniel J Bell had no recorded disclosures.
View Daniel J Bell's current disclosuresAt the time the article was last revised Arlene Campos had no financial relationships to ineligible companies to disclose.
View Arlene Campos's current disclosures- Middle turbinate pneumatization
- Middle turbinate pneumatisation
- Conchae bullosae
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.
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Epidemiology
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).
Clinical presentation
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. An enlarged concha bullosa in the middle turbinate could obstruct the middle meatus or infundibulum, leading to symptoms of nasal obstruction 8.
Conchae bullosae are associated with deviation of the nasal septum (see below) which has itself been in some studies associated with an increased incidence of sinus disease 1,5.
Radiographic features
Although in most instances concha bullosa refers specifically to pneumatization of the middle concha, similar appearances may be occasionally seen of either the superior or inferior conchae.
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).
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.
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.
References
- 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 H, Cetin M, Yüksel E. Concha Bullosa Types: Their Relationship with Sinusitis, Ostiomeatal and Frontal Recess Disease. Diagn Interv Radiol. 2005;11(3):145-9. - Pubmed
- 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. Heinz Stammberger, Wolfgang Kopp, Gino Hasler. Functional Endoscopic Sinus Surgery. (1991) ISBN: 9780941158961 - Google Books
- 5. Elahi M, 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
- 6. Ballenger's Otorhinolaryngology: Head and Neck Surgery, 17th Edition. (2008) ISBN: 1550093371 - Google Books
- 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
- 8. 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):E16-8. doi:10.1177/014556131209100518 - Pubmed
Incoming Links
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