A paradoxical middle turbinate is an anatomical variation that predisposes to impaired discharge through the ostiomeatal unit and nasal obstruction. It refers to an inferomedially curved middle turbinate edge with the concave surface facing the nasal septum. It is commonly bilaterally.
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Epidemiology
Paradoxical middle turbinate is a commonly encountered anomaly and can be easily recognized in CT paranasal 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.
Prevalence ranges from 9-34% 3,6,7. When present it is bilateral in 40-80% of cases 3.6.
Clinical presentation
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. Particularly when associated with a concha bullosa, it can potentially lead to nasal obstruction 2.
Radiographic features
CT
The morphology of the middle turbinate is best evaluated on coronal CT of the paranasal sinuses.
The normal morphology of the middle turbinate has its concavity facing laterally. In contrast, paradoxical middle turbinates have their concavity facing the nasal septum.
Treatment and prognosis
If asymptomatic, a paradoxical middle turbinate does not require treatment. In cases where it contributes to sinus disease then it may be partially resected endoscopically 8.
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