Paradoxical middle turbinate

Paradoxical middle turbinate is a rare developmental cause of nasal obstruction. It refers to an inferomedially curved middle turbinate edge with the
concave surface facing the nasal septum, and usually occurs bilaterally.

Paradoxical middle turbinate is a rarely encountered anomaly and can be easily recognized in CT paransal sinuses but can be overlooked on endoscopic examination 3.

The prevalence reported by different authors may diverge because some of them consider any involved portion of the turbinate as paradoxical curvature, whereas others may consider this variation only in cases where the whole turbinate is unusually curved towards the opposite side 4.

Another study indicated paradoxical middle turbinate represents 9% of total anatomical variations.

The nasal turbinates are important structures of the nasal cavity. The inferior turbinates are considered a separate bone, conversely both the middle and superior turbinates are part of the ethmoid bone. Their position and relationship to other important anatomic landmarks is extremely important especially in skull base and ENT surgical procedures 1.

This anatomic variant alone can lead to significant narrowing of the middle nasal meatus and impede the normal drainage of paranasal sinuses due to ostiomeatal complex obstruction 2. When associated with a bulbous middle turbinate, it can potentially lead to nasal obstruction 2.

A study was done on 150 patients of chronic rhinosinusitis and found the following anatomical variants 5:

Functional endoscopic sinus surgery (FESS) has revolutionized the approach and treatment of chronic rhinosinusitis. Certain anatomical variations are thought to be predisposing factors for the development of sinus disease and it is necessary for the surgeon to be aware of these variations, especially if the patient is a candidate for FESS 5.

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Article information

rID: 47185
System: Head & Neck
Section: Anatomy
Tags: cases, snippet
Synonyms or Alternate Spellings:
  • Paradoxical middle turbinates

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