Paradoxical rotation of the middle turbinates

The cribriform plate is intact. Olfactory recesses are measuring approximately 6.5-7 mm consistent with Keros II on both sides. Lamina papyracea is intact bilaterally. No Onodi cells on either side. Bilateral multiple Haller cells causing mild infundibular narrowing, bilateral dependent retention cyst/polyp larger on the right maxillary antra causing about 50% opacification.

Normal anterior ethmoid air cells, frontal sinuses, and frontal recesses. The spheno-ethmoidal recesses are patent. Normal sphenoid sinus and posterior ethmoid air cells. There are no air-fluid levels, bony dehiscence, erosion, or osteitis.

Pneumatization of the sphenoid sinus is complete sellar and laterally extends into both anterior clinoid processes, with a single intersinus septum bifid superiorly with one end inserted at the right optic canal. The relation of the optic nerve with the sphenoid sinus is DeLano type II—Optic nerve causing impression on the lateral sphenoid sinus wall. No carotid canal protrusion into the sphenoid sinuses. The anterior ethmoidal artery runs below the skull base bilaterally with an average distance of 2 mm.

Mild mucosal thickening over the hypertrophied inferior turbinates. Angular septal deviation to the right was noted at the mid-bony portion with a 3.5 x 2 mm spur contacting the right middle turbinate, with gentle C-shaped cartilaginous septal deviation to the right. Bilateral middle lamellar concha bullosa with paradoxical rotation. The superior attachment of the uncinate process is type II into the posterior wall of aggar nasi cells bilaterally.