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

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.

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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.

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Incidence of concha bullosa and its role in chronic rhinosinusitis

International Journal of Otorhinolaryngology and Head and Neck Surgery ◽

10.18203/issn.2454-5929.ijohns20212788 ◽

2021 ◽

Author(s):

Yalagandula Vijaya Lakshmi ◽

Thakur Dinesh Singh ◽

Razia Fathima ◽

Vaddi Hemanth Kumar

Keyword(s):

Chronic Rhinosinusitis ◽

Chronic Sinusitis ◽

Middle Turbinate ◽

Sinus Surgery ◽

Concha Bullosa ◽

Medical Sciences ◽

Osteomeatal Complex ◽

History Of ◽

Mucosal Edema ◽

Surgical Manipulation

Background: Pneumatization of nasal turbinates is called concha bullosa. Most often it involves the middle turbinate and is one of the commonest variants of sinonasal anatomy. Bulbous and extensive type of concha bullosa may lead to narrowing or even complete blockage of osteomeatal complex. This alters the normal airflow and drainage pathways of mucous, resulting in mucosal edema which obstructs the ethmoidal infundibulum and osteomeatal obstruction leading to sinusitis. The aim of the study was to determine the incidence of concha bullosa and assess its role in causation of chronic rhinosinusitis. The objective was to determine the incidence of concha bullosa and assess its role in chronic rhinosinusitis.Methods: A retrospective study of 120 patients suffering from chronic sinusitis of age group 18 years to 70 years old were taken between March 2018 to January 2021 at Malla Reddy institute of medical sciences (MRIMS) who had nasal symptoms significant enough to warrant a CT paranasal sinus (CT PNS) with positive findings. All PNSs involved were identified for sinus disease. Concha bullosa identified and graded into small, moderate and large. Patients with history of previous nasal surgeries were excluded.Results: Our study showed 54% cases of chronic sinusitis with concha bullosa.Conclusions: Concha bullosa may be one of the predisposing factors of chronic rhinosinusitis and hence surgical manipulation by functional endoscopic sinus surgery (FESS) is important to prevent recurrence of sinusitis.

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

International Archives of Otorhinolaryngology ◽

10.1055/s-0038-1625978 ◽

2018 ◽

Vol 22 (03) ◽

pp. 297-302 ◽

Cited By ~ 6

Author(s):

Raja Kalaiarasi ◽

Venkataramanan Ramakrishnan ◽

Santhosh Poyyamoli

Keyword(s):

Paranasal Sinus ◽

Chronic Sinusitis ◽

Middle Turbinate ◽

Anatomical Variations ◽

Neck Surgery ◽

Detailed Knowledge ◽

Concha Bullosa ◽

Anatomical Variant ◽

Radiologic Study ◽

The Right

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.

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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.

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Incidence of sinonasal anatomical variations associated with chronic sinusitis by CT scan in Karaikal, South India

International Journal of Otorhinolaryngology and Head and Neck Surgery ◽

10.18203/issn.2454-5929.ijohns20172291 ◽

2017 ◽

Vol 3 (3) ◽

pp. 576 ◽

Cited By ~ 1

Author(s):

Kranti Gouripur ◽

Udaya Kumar M. ◽

Anand B. Janagond ◽

S. Elangovan ◽

V. Srinivasa

Keyword(s):

Ct Scan ◽

Endoscopic Sinus Surgery ◽

Frontal Sinus ◽

Chronic Sinusitis ◽

Middle Turbinate ◽

Anatomical Variations ◽

Uncinate Process ◽

Sinus Surgery ◽

Nasal Endoscopy ◽

Deviated Nasal Septum

Background: Variations in sinonasal anatomy of adults are common and vary among different populations. Their role in development of pathological conditions such as sinusitis, epistaxis, etc is debated. Having clear picture of sinonasal anatomy of a person is essential in avoidance of complications during surgery. This study was done to analyze sinonasal anatomy in adults from Karaikal region having chronic sinusitis by nasal endoscopy and CT scan imaging.Methods: A total of 50 patients undergoing endoscopic sinus surgery were studied by preoperative nasal endoscopy, CT scanning and endoscopy at the time of definitive surgery and variations recorded and analyzed. Results: The incidence of the sinonasal anatomical variations in CT scan study were – discharge in the frontal sinus (100%), agger nasi cells (96%), deviated nasal septum (70%), anterior ethmoidal cells (86%), posterior ethmoidal cells (58%), sinus lateralis (52%), frontal cells (50%), discharge in sphenoid sinus (50%), pneumatised superior turbinate (46%), INSA (34%), prominent bulla ethmoidalis (30%), supra orbital cells (26%), pneumatised septum(16%), medialised uncinate process (16%), paradoxical middle turbinate (16%), Haller cells (14%), supreme turbinate (14%), pneumatised inferior turbinate (12%), frontal recess obliteration (12%), absent pneumatisation of frontal sinus (12%), pneumatised middle turbinate (10%), Onodi cells (6%), pneumatised uncinate process (2%), maxillary sinus septation (2%).Conclusions: The high incidence of variations emphasises the need for proper preoperative assessment for safe and effective endoscopic sinus surgery.

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CT Scan Evaluation of Prevalence of Paradoxical Middle Turbinate In Adult Population of Bihar

Academia Anatomica International ◽

10.21276/aanat.2020.6.1.1 ◽

2020 ◽

Vol 6 (1) ◽

pp. 01-04

Author(s):

Raag Reeti ◽

Md Jawed Akhtar ◽

Avanish Kumar ◽

Binod Kumar ◽

Rajiv Ranjan Sinha

Keyword(s):

Convex Surface ◽

Adult Population ◽

Middle Turbinate ◽

Lateral Wall ◽

Anatomical Variations ◽

Sinus Surgery ◽

P Value ◽

Test Results ◽

Common Cause ◽

Exact Test

Introduction: Middle turbinate overlying the middle meatus is the most important anatomic area in the lateral wall of the nose. It is a thinsheet of bone which curves in different planes very similar to a dried leaf. Paradoxical Middle Turbinate (PMT) is the abnormal curvatureof middle turbinate, where the convex surface faces laterally instead of its usual medial curvature and may block the drainage pathway ofmiddle meatus. The present study aimed at observing the prevalence of the paradoxical middle turbinate in the adult population of Bihar. Subjects and Methods: This was a retrospective study being conducted on 150 patients who presented to the Department of Radiodiagnosis. Their CT scans were analysed for the presence of paradoxical middle turbinate. The results were analysed as percentage and ‘p’ value was calculated using Fischer’s Exact Test. Results: Prevalence of Paradoxical Middle Turbinate was observed in 28 cases i.e. 18.6% cases; 16 in males and 12 in females. ‘p’ value was 0.677 on applying Fisher’s Exact test. Conclusion: Anatomical variations of the paranasal sinus region like paradoxical middle turbinate are quite common cause of diseases involving paranasal sinuses and they must be searched for by the surgeons planning any endoscopic sinus surgery. This study attempted to provide the prevalence of the paradoxical middle turbinate which will definitely help the FESS surgery and its outcomes.

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Anatomical Variations in Osteomeatal Complex among Patients undergoing Functional Endoscopic Sinus Surgery

Clinical Rhinology An International Journal ◽

10.5005/jp-journals-10013-1259 ◽

2016 ◽

Vol 9 (1) ◽

pp. 28-32 ◽

Cited By ~ 2

Author(s):

V Narendrakumar ◽

V Subramanian

Keyword(s):

Endoscopic Sinus Surgery ◽

Middle Turbinate ◽

Preoperative Assessment ◽

Ct Scanning ◽

Anatomical Variations ◽

Uncinate Process ◽

Functional Endoscopic Sinus Surgery ◽

Sinus Surgery ◽

Frequency Of Occurrence ◽

Osteomeatal Complex

ABSTRACT Aims To study the anatomical variations of osteomeatal complex and the importance of preoperative computed tomography (CT) in patients with chronic sinusitis undergoing functional endoscopic sinus surgery. We studied the different variations and their frequency of occurrence. Materials and methods A total of 100 patients undergoing endoscopic sinus surgery were studied by nasal endoscopy, CT scanning, and at the time of definitive surgery, variations were recorded. Results The frequency of occurrence of sinonasal anatomical variations was septal deviation in 76%, agger nasi cells in 71%, concha bullosa in 61%, medialized uncinate process in 48%, prominent bulla ethmoidalis in 41%, paradoxical middle turbinate in 33%, accessory maxillary ostium in 28%, frontal cell in 22%, intumescentia septi nasi anterior in 21%, lateralized uncinate in 15%, pneumatized uncinate process in 4%, Haller cells in 12%, and Onodi cells in 8%. Conclusion The high incidence of variations emphasizes the need for proper preoperative assessment for safe and effective endoscopic sinus surgery. How to cite this article Narendrakumar V, Subramanian V. Anatomical Variations in Osteomeatal Complex among Patients undergoing Functional Endoscopic Sinus Surgery. Clin Rhinol An Int J 2016;9(1):28-32.

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Polyps originating from accessory middle turbinate and secondary middle turbinate

The Journal of Laryngology & Otology ◽

10.1017/s0022215112000941 ◽

2012 ◽

Vol 126 (7) ◽

pp. 729-732 ◽

Cited By ~ 3

Author(s):

H Jung ◽

S K Park ◽

J-R Kim

Keyword(s):

Computed Tomography ◽

Case Report ◽

World Literature ◽

Middle Turbinate ◽

Anatomical Variations ◽

Sinus Surgery ◽

Histopathological Analysis ◽

Middle Meatus ◽

The World ◽

Paranasal Sinus Computed Tomography

AbstractObjective:We report two extremely rare cases of polyps from unilateral accessory middle turbinates, one of which coexisted with a polyp from an inferomedially projecting, pneumatised, secondary middle turbinate.Methods:Case report and literature review concerning accessory middle turbinate and secondary middle turbinate.Results:Two patients presented with unilateral nasal obstruction. In both patients, nasal endoscopy revealed polypoid masses originating from the middle meatus. Paranasal sinus computed tomography and histopathological analysis confirmed the presence of polyps originating from an accessory middle turbinate and secondary middle turbinate, which were resected uneventfully via endoscopic sinus surgery.Conclusion:To our knowledge, this is the first report in the world literature of polyps originating from a unilateral accessory middle turbinate and secondary middle turbinate. Pre-operative recognition of these rare anatomical variations is of particular importance in avoiding intra-operative complication.

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Initial Report on Postoperative Healing after Endoscopic Sinus Surgery With the Microdebrider

Otolaryngology ◽

10.1016/s0194-5998(98)70272-4 ◽

1998 ◽

Vol 118 (6) ◽

pp. 800-803 ◽

Cited By ~ 40

Author(s):

JOSEPH M. BERNSTEIN ◽

RICHARD A. LEBOWITZ ◽

JOSEPH B. JACOBS

Keyword(s):

Endoscopic Sinus Surgery ◽

Chronic Sinusitis ◽

Middle Turbinate ◽

Mucosal Healing ◽

Sinus Surgery ◽

Crust Formation ◽

Initial Report ◽

Low Incidence ◽

Head Neck

Synechiae formation is a frequent occurrence after endoscopic sinus surgery and may cause symptomatic sinus outflow tract obstruction. Various means are used to reduce the incidence of synechiae formation. These include meticulous operative technique, partial middle turbinate resection, middle meatus spacers or stents, and postoperative debridement. The microdebrider is a powered rotary shaving device that precisely resects tissue, minimizing inadvertent mucosal trauma and stripping. We present 40 cases of endoscopic sinus surgery performed with the microdebrider. Patients had at least a 5-month follow-up and demonstrated rapid mucosal healing, minimal crust formation, and a low incidence of synechiae formation. These initial data suggest that the microdebrider may be advantageous in surgery for chronic sinusitis. (Otolaryngol Head Neck Surg 1998;118:800–3.

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Fungus ball in concha bullosa, an unusual site: a case report from hilly region

International Journal of Otorhinolaryngology and Head and Neck Surgery ◽

10.18203/issn.2454-5929.ijohns20175648 ◽

2017 ◽

Vol 4 (1) ◽

pp. 301

Author(s):

Shaweta . ◽

R. S. Minhas ◽

Vineeta Sharma ◽

Santwana Verma ◽

Trilok C. Guleria

Keyword(s):

Case Report ◽

Sphenoid Sinus ◽

Case Reports ◽

Middle Turbinate ◽

Sinus Surgery ◽

Fungus Ball ◽

Concha Bullosa ◽

Rare Presentation ◽

Unusual Site ◽

Hilly Region

Fungus is a rare cause of rhinosinusitis in children. Its incidence has been reported as ranging between 13.5 and 28%. Fungus balls are extramucosal tangled masses of fungal hyphae. It commonly involves just one paranasal sinus. Most commonly maxillary sinus is involved and occasionally sphenoid sinus. Concha bullosa is one of the most common anatomical variations in the nasal cavity, with a frequency of reporting ranging from 14-53.6%. There are very few case reports in which Concha bullosa was affected with fungus ball. In this case report 13 years female child presented with complaints of swelling right cheek. The patient underwent endoscopic sinus surgery and there was involvement of concha bullosa and sphenoid sinus with fungus ball. Fungus was confirmed on microscopic examination and culture. Fungus ball is a rare presentation of fungal rhinosinusitis. It should be considered in enlarged middle turbinate with heterogenous opacity on CT. The diagnosis should be confirmed by microscopy or culture.

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