Anatomical Variations of the Middle Turbinate Concha Bullosa and its Relationship with Chronic Sinusitis: A Prospective Radiologic Study

Introduction A pneumatized turbinate, also called concha bullosa, is a normal anatomical variant of the paranasal sinus region. Depending on the site of pneumatization, the concha is classified into extensive, bulbous or lamellar type. The middle turbinate concha bullosa has been implicated as a possible etiological factor in chronic sinusitis. Objectives The aim of this study was to investigate the anatomical variations of the concha bullosa, based on paranasal sinus imaging, and its possible association with sinusitis. Methods This prospective descriptive study was performed at the Department of ENT and Head Neck Surgery over a period of one year, from 2016 to 2017. We studied the computed tomography scans of the nose and paranasal sinuses— in axial, coronal and sagittal planes—of patients who had symptoms of nasal obstruction, or headache and features of chronic sinusitis. Results Out of the 202 scans studied, the prevalence of concha bullosa was 31.7%. The concha was bilateral in 35 (54.7%) patients and unilateral in 29 (45.3%) patients. Out of 99 conchae, 54 were on the right side and 45 were on left side. Ipsilateral sinusitis was found in 40.4% of the sides in the scans of subjects with concha. There was no statistically significant association between any type of middle turbinate concha with sinusitis, but sinusitis was more predominant with the extensive type of concha (p > 0.05). Conclusion Multiple air cells, mucocele, pyocele and inflammatory mucosal thickenings in the concha are relatively rare. Detailed knowledge of anatomic variations of the concha bullosa is imperative for the radiologists and the operating surgeons.

Download Full-text

Anatomical variations in patients with chronic sinusitis

International Journal of Otorhinolaryngology and Head and Neck Surgery ◽

10.18203/issn.2454-5929.ijohns20180702 ◽

2018 ◽

Vol 4 (2) ◽

pp. 428 ◽

Cited By ~ 1

Author(s):

Pragadeeswaran Kumarasekaran ◽

Rajprakash Dharmapuri Yadhava krishnan ◽

Gurumani Sriraman

Keyword(s):

Nasal Septum ◽

Chronic Sinusitis ◽

Anatomical Variation ◽

Middle Turbinate ◽

Anatomical Variations ◽

Uncinate Process ◽

Sinus Surgery ◽

Concha Bullosa ◽

Deviated Nasal Septum ◽

Anatomical Variant

Background: Chronic sinusitis is repeated bouts of acute infection or persistent inflammation of the sinuses. The range of anatomic variants that can interfere with the mucociliary drainage of osteomeatal complex including concha bullosa, deviated nasal septum, uncinate process variations, ethmoid bulla, paradoxical middle turbinate, agger nasi and Haller cells. This is also important in surgeon point of view to know about detail knowledge of lateral nasal wall, paranasal sinuses, surrounding vital structures and anatomical variation. Methods: Observational case series study in which 90 cases of chronic rhinosinusitis patients attending the ENT outpatient department from November-2015 to November-2016 in Shri Sathya Sai Medical college and Hospital, who had chronic sinusitis for more than three months duration not responding to the medical line treatment and who are willing to undergo functional endoscopic sinus surgery are studied and statistically analysed. Results: In our study we found anatomical variation in 93% of chronic sinusitis patients. In our study it was observed that 52% of patients with two anatomical variation, 41% patients presented with single anatomical variation and 7% patients presented with no anatomical variation. In our study deviated nasal septum was the most common anatomical variant noted followed by unilateral concha bullosa, medialized uncinate process, paradoxical middle turbinate, haller cell and agger nasi. Conclusions: In our study it was concluded that presence of anatomical variations is common in patients with chronic sinusitis. Presence of more than one anatomical variations significantly contributes to disease process. Deviated nasal septum is the most common anatomical variation in our study followed by concha bullosa, medialized uncinate process.

Download Full-text

Triple-Divided Concha Bullosa: A New Anatomic Variation

Case Reports in Otolaryngology ◽

10.1155/2013/342615 ◽

2013 ◽

Vol 2013 ◽

pp. 1-3 ◽

Cited By ~ 2

Author(s):

Turhan San ◽

Barış Erdoğan ◽

Bülent Taşel

Keyword(s):

Computed Tomography ◽

Paranasal Sinus ◽

Imaging Techniques ◽

Anatomic Variation ◽

Middle Turbinate ◽

Anatomical Variations ◽

Concha Bullosa ◽

Paranasal Sinus Computed Tomography

In recent years, with the widespread use of imaging techniques such as paranasal sinus computed tomography (CT), many variations of nasal turbinates have been described. One of these variations known as concha bullosa (CB) is pneumatization of nasal turbinates. CB is the most frequently encountered anatomical variations of the middle turbinate. The term of septated concha bullosa has been described recently and it is an uncommon pneumatization anomaly of the middle turbinate. There has not been any study that correlates the number of septations and the presence of sinonasal pathologies. We hereby present a case of triple septated concha bullosa that has not been reported so far.

Download Full-text

Peroperative Findings of the Middle Turbinate in 50 Patients With Chronic Sinusitis Who Underwent Total Spheno-Ethmoidectomy

Diagnostic and Therapeutic Endoscopy ◽

10.1155/dte.5.1 ◽

1998 ◽

Vol 5 (1) ◽

pp. 1-8

Author(s):

T. D. Morre ◽

P. A. R. Clement ◽

G. Noussios

Keyword(s):

Chronic Inflammation ◽

Chronic Sinusitis ◽

Middle Turbinate ◽

Anatomical Variations ◽

Sinus Surgery ◽

Concha Bullosa ◽

Frequent Change ◽

Endoscopic Findings ◽

Mucosal Changes

This study describes the peroperative endoscopic findings about the size, shape and mucosal changes of the middle turbinate in patients with chronic sinusitis who underwent total spheno-ethmoidectomy. Results confirmed the middle turbinate to be a useful landmark in performing extensive sinus surgery. The most frequent change due to chronic inflammation seems to be polypous degeneration followed by hyperplastic mucosa. Anatomical variations, being paradoxically bent turbinate and concha bullosa, are not seen frequently.

Download Full-text

Multi Detector Computed Tomographical Assessment of Anatomical Variants of Paranasal Sinuses

Journal of Pharmaceutical Research International ◽

10.9734/jpri/2021/v33i44b32684 ◽

2021 ◽

pp. 335-340

Author(s):

P. K. Roopa Rajavarthini ◽

I. Venkatraman

Keyword(s):

Paranasal Sinuses ◽

Endoscopic Sinus Surgery ◽

Middle Turbinate ◽

Anatomical Variations ◽

Sinus Surgery ◽

Age Group ◽

Concha Bullosa ◽

Anatomical Variant ◽

The Mean ◽

Study Participants

Multi detector computed tomography (MDCT) scan of paranasal sinuses has become mandatory for all patients undergoing functional endoscopic sinus surgery. It depicts the anatomical variations in much simpler way and acts as a roadmap for endoscopic sinus surgery. In this study the maximum of participants were in the age group of 41- 50 years (32 %). The mean age of the study participants was observed to be 43.8 ± 15.6 years. HRCT PNS results shows nasal septum was found to be the most common anatomical variant (DNS- 94%). Concha Bullosa in right side were seen in 37.5% and left side were 21.9% (total unilateral cases- 59.4%) and bilateral Concha Bullosa were seen in 40.6% of the cases. Agger nasi were found to be present in 58% of the CRS cases among which right AN was 41%, left side was 30.8%, and bilateral AN were seen in 28.2% of the cases and Paradoxical Middle Turbinate were seen in 42% of cases in our study. Medialised uncinate was seen in 22% of the cases.

Download Full-text

Middle turbinate concha bullosa and its relationship with chronic sinusitis: a review

International Journal of Otorhinolaryngology and Head and Neck Surgery ◽

10.18203/issn.2454-5929.ijohns20212136 ◽

2021 ◽

Vol 7 (6) ◽

pp. 1062

Author(s):

Santosh Kumar Swain

Keyword(s):

Ct Scan ◽

Paranasal Sinuses ◽

Chronic Sinusitis ◽

Middle Turbinate ◽

Review Article ◽

Concha Bullosa ◽

Health Issues ◽

Anatomical Variant ◽

Anatomical Variants ◽

Air Cells

Sinonasal diseases are serious health issues found in the clinical practice. Sinonasal diseases are often associated with anatomical variants in the sinonasal tract. There are numerous sinonasal anatomical variants found frequently in computed tomography (CT) scans of the paranasal sinuses. Middle turbinate concha bullosa is a common anatomical variant found in the nasal cavity. Pneumatization of the middle turbinate is called as concha bullosa. The pneumatization of the middle turbinate is mostly via the anterior ethmoidal air cells. Pneumatizations through posterior ethmoid air cells are also reported. There are three types of concha bullosa such as lamellar, bulbous and extensive. Majority of the patients with middle turbinate concha bullosa are asymptomatic. Sometimes this is accidentally detected during proper evaluation of the headache. Sometimes the middle turbinate concha bullosa is associated with chronic sinusitis. However, there are very few literatures which correlate the middle turbinate concha bullosa and chronic sinusitis. Although chronic sinusitis is a clinical diagnosis, the imagings like CT scan are useful to assess the extent of the disease and demonstrate the sinonasal anatomy. CT scan of the paranasal sinuses and diagnostic nasal endoscopy are important tests useful for evaluation of the middle turbinate concha bullosa and its relations with chronic sinusitis. This review article discusses on the details of the middle turbinate concha bullosa and its relationship with chronic sinusitis.

Download Full-text

Study of anatomical variations of ostiomeatal complex in chronic rhinosinusitis patients

International Journal of Otorhinolaryngology and Head and Neck Surgery ◽

10.18203/issn.2454-5929.ijohns20183696 ◽

2018 ◽

Vol 4 (5) ◽

pp. 1281

Author(s):

Shivakumar Senniappan ◽

Komathi Raja ◽

Ammu Lizbeth Tomy ◽

Chinnu Sudha Kumar ◽

Anjali Mahendra Panicker ◽

...

Keyword(s):

Chronic Rhinosinusitis ◽

Maxillary Sinusitis ◽

Middle Turbinate ◽

Anatomical Variations ◽

Deviated Nasal Septum ◽

Prospective Longitudinal Study ◽

Anatomical Variant ◽

Persistent Symptoms ◽

Ostiomeatal Complex ◽

Prospective Longitudinal

Background: Anatomical variations like nasal septal deviations, concha bullosa, paradoxical middle turbinate, pneumatized or medially bent uncinate etc. can encroach upon the ostiomeatal unit and narrow ostiomeatal channels. The aim of the study was to study the anatomical variations of ostiomeatal complex commonly associated with paranasal sinus disease among patients with chronic sinusitis using computed tomography.Methods: A prospective longitudinal study was conducted in the ENT department of our hospital for a period of one year. All the adult patients with complaints suggestive of chronic rhinosinusitis for a period of more than 12 weeks, patients with acute exacerbation of chronic rhinosinusitis and with persistent chronic rhinosinusitis requiring surgical intervention are included in our study. Based on our inclusion and exclusion criteria a total of 138 patients were involved in the study. Results: In our study we saw the association between various sinusitis and the anatomic variations of the ostiomeatal complex and we found that concho bullosa found to have a strong significant association with maxillary sinusitis (43.6%) and anterior ethmoid sinusitis (42.1%). Most of the patients with posterior ethmoid sinusitis (53.8%) had a statistical significant association in developing deviated nasal septum type of anatomical variant and majority of the patients with sphenoidal sinusitis had a onodi cell type of anatomical variant and their association was found to be statistical significant (p<0.05).Conclusions: The importance of CT scan and nasal endoscopy is emphasized in patients with persistent symptoms to identify the anatomical variations that may contribute to the development of chronic sinus mucosal disease.

Download Full-text

Comparison Between the Anterior Ventricular Wall Thickness, Left and Right, and Considerations on Trabecular System of the Two Ventricles

ARS Medica Tomitana ◽

10.2478/arsm-2018-0013 ◽

2018 ◽

Vol 24 (2) ◽

pp. 72-76

Author(s):

Gheorghiţescu Jancă Ruxandra ◽

Iliescu Dan Marcel ◽

Bordei Petru ◽

Popescu-Chiriloaie Cristina ◽

Tobă Marius

Keyword(s):

Anatomical Variations ◽

Ventricular Wall ◽

Papillary Muscles ◽

Anatomical Variant ◽

Anatomical Terminology ◽

Ventricular Wall Thickness ◽

Late Twentieth ◽

Left And Right ◽

The Right ◽

Late Twentieth Century

Abstract In recent decades (late twentieth century), have been reported multiple anatomical variations in relation to the concepts described classic, so what once was described as an anatomical variant in some cases has become predominant, not quite often proposing a revision of international anatomical terminology. This article is specifically addressed on the morphology of the papillary muscles of the two ventricles, describing the differences between the left and the right anterior ventricular walls.

Download Full-text

Unilateral rectus sternalis muscle - a case report

National Journal of Clinical Anatomy ◽

10.1055/s-0039-3401606 ◽

2016 ◽

Vol 05 (03) ◽

pp. 172-175

Author(s):

Smitha S Nair ◽

K Jayasree ◽

Ashalatha PR ◽

Jenish Joy

Keyword(s):

Case Report ◽

Surgical Procedures ◽

Pectoralis Major Muscle ◽

Anatomical Variations ◽

Anterior Chest Wall ◽

Superficial Fascia ◽

Anatomical Variant ◽

Incorrect Diagnosis ◽

The Right ◽

Sternalis Muscle

AbstractRectus sternalis muscle, either unilateral or bilateral is an uncommon anatomical variant among the anterior chest wall muscles. During the routine dissection as a part of undergraduate medical teaching in the department of Anatomy, a unilateral rectus sternalis muscle was noticed on the right hemi thorax in one cadaver, located adjacent to the sternum between the pectoralis major muscle and the superficial fascia of the region. Though rare in occurrence, when present, rectus sternalis muscle demands proper awareness and attention by the clinicians especially radiologists and surgeons, as the ignorance of the existence of this muscle may lead to misinterpretation, incorrect diagnosis and unnecessary clinical interventions. Such anatomical variations should be borne in mind while doing radiological investigations, radiotherapy and surgical procedures in the chest region.

Download Full-text

Anatomical Variations of Uncinate Process in a Tertiary Care Hospital of a Coastal city in Karnataka

Asian Journal of Medicine and Health ◽

10.9734/ajmah/2021/v19i1130394 ◽

2021 ◽

pp. 17-21

Author(s):

Carol Jacob ◽

Anita Aramani ◽

Basavaraj N. Biradar ◽

Shaista Naaz

Keyword(s):

Tertiary Care ◽

Middle Turbinate ◽

Anatomical Variations ◽

Uncinate Process ◽

Ciliary Activity ◽

Care Hospital ◽

Lamina Papyracea ◽

Osteomeatal Complex ◽

The Right ◽

Observational Descriptive Study

Introduction: Superior attachment of uncinate process is the most important anatomical landmark in frontal recess surgery. The uncinate process is an integral structure of osteomeatal complex and prevents the direct contact of the inspired air with the maxillary sinus. It acts as a shield and also plays a role in muco-ciliary activity. Anatomic variations of the uncinate process have surgical implications. Aim: This study was done to know the different variations of superior attachment of uncinate process. Materials and Methods: In this retrospective observational descriptive study, Computed Tomography (CT) scans of Para Nasal Sinuses (PNS) of 256 patients from Sept 2018 to May 2020 were studied. The results were expressed in percentages and proportions. Results: Among 256 CT images, 139 belonged to males and 117 females. In the CT films examined, on the right side, the most common attachment of uncinate was to lamina papyracea which was (64.8%) followed by skull base (19.5%) and to the middle turbinate(15.6%). Similar findings were seen on left side. Conclusion: Uncinate process shows different variations in its superior attachment. Superior attachment to lamina papyracea was the most common attachment of uncinate in our study.

Download Full-text

CT evaluation of anatomical variations of paranasal sinus region and their clinical importance

International Journal of Research in Medical Sciences ◽

10.18203/2320-6012.ijrms20192509 ◽

2019 ◽

Vol 7 (6) ◽

pp. 2260

Author(s):

Tapendra Nath Tiwari ◽

Narendra Kumar Kardam

Keyword(s):

Paranasal Sinus ◽

Paranasal Sinuses ◽

Anatomical Variation ◽

Intraoperative Complications ◽

Preoperative Evaluation ◽

Anatomical Variations ◽

Uncinate Process ◽

Concha Bullosa ◽

Increased Risk ◽

Mucosal Changes

Background: Paranasal sinuses are air filled spaces present within the skull and facial bones. Paranasal sinuses region anatomy is highly variable. Knowledge of these variations is very important for radiologists as well as endoscopic surgeons for preoperative evaluation to avoid damage to adjacent vital structures. CT is the best modality to delineate the sinus anatomy as well as soft tissue structures. Thus, this study was undertaken to evaluate the anatomical variations of paranasal sinus region and ascertain their clinical importance.Methods: A total of 142 patients, those referred from various outdoor/indoor departments with the symptoms related to nose and paranasal sinuses were included. Detailed history, appropriate clinical examinations, biochemical investigations and X-ray PNS were recorded. Unenhanced CT scan of the PNS was performed for these patients in the axial planes and reformatted coronal planes. Observation was made and analysed using descriptive tools and scientific methods.Results: Deviated nasal septum was the most common variation followed by middle concha bullosa, Paradoxical middle turbinate, curved uncinate process, overpneumatized ethmoidal bulla, superior concha bullosa, prominent Agger Nasi cells, haller cells, onodi cells, maxillary sinus septae and pneumatization of uncinate process. Incidence of anatomical variation was 75% among the patients showing PNS mucosal changes while it was 94% among patients showing no mucosal changes. Chi square statics revealed that presence of anatomical variation does not mean a predisposition to mucosal changes.Conclusions: The presence of anatomical variants does not indicate predisposition to sinus pathology but may predispose to increased risk of intraoperative complications. It is important to pay close attention to anatomical variations in the preoperative evaluation to avoid possible complications.

Download Full-text