Concha bullosa: reducing middle meatal adhesions by preserving the lateral mucosa as a posterior pedicle flap

2004 ◽  
Vol 118 (10) ◽  
pp. 799-803 ◽  
Author(s):  
Elizabeth A.W. Sigston ◽  
Claire E. Iseli ◽  
Tim A. Iseli
Keyword(s):  
Middle Turbinate ◽  
Pedicled Flap ◽  
Lateral Nasal Wall ◽  
Consecutive Series ◽  
Concha Bullosa ◽  
Modified Technique ◽  
Pedicle Flap ◽  
Simple Modification ◽  
Mucosal Flap

Background: Concha bullosa, an extensively pneumatized middle turbinate, may obstruct the paranasal sinuses. Messerklinger’s partial lateral turbinectomy is commonly used to debulk the concha bullosa, leaving a raw surface with the potential for adhesions.Materials and methods: A modified technique of partial lateral turbinectomy is described. A posterior pedicled mucosal flap covers the inferior raw surface of the medial lamella of the middle turbinate. Three-month follow up of a consecutive series is compared with concurrent controls. Results: Two (7 per cent) of 28 posterior pedicled flap and four (21 per cent) of 19 traditional partial lateral turbinectomies developed mild middle meatal adhesions (p = 0.011). Posterior pedicled flap reduced the need for post-operative cleaning of the middle meatus.Conclusion: The posterior pedicled mucosal flap is a simple modification to partial lateral turbinectomy that covers the raw surface facing the lateral nasal wall, significantly reducing adhesions and speeding recovery.

Middle Turbinate Headache Syndrome

1993 ◽  
Vol 7 (1) ◽  
pp. 17-23 ◽  
Author(s):  
Ari J. Goldsmith ◽  
Gerald D. Zahtz ◽  
Arsen Stegnjajic ◽  
Mark Shikowitz
Keyword(s):  
Inflammatory Disease ◽  
Facial Pain ◽  
Clinical Presentation ◽  
Middle Turbinate ◽  
Trigger Points ◽  
Sensory Innervation ◽  
Lateral Nasal Wall ◽  
Concha Bullosa ◽  
Headache Syndrome ◽  
Sinus Mucosa

Sinus headaches are attributed to inflammatory disease of the sinus mucosa or ostium. In 1948 H.G. Wolff first recognized that sinus headaches may occur in the absence of inflammatory sinusitis, and may be due to contact between strategic “trigger points” in the sinonasal passages. Since this time there have been sporadic reports of headaches and facial pain due to an enlarged middle turbinate contacting either the septum or lateral nasal wall. It is theorized that an enlarged middle turbinate, most commonly due to pneumatization (concha bullosa), can contact the septum or lateral nasal wall and give headaches referred to the ophthalmic division of the trigeminal nerve, the main sensory innervation of the anterior middle turbinate. Middle turbinate headache syndrome is reviewed, with attention to pathophysiology, clinical presentation, and treatment. Eight cases of middle turbinate headache will be presented in support of this clinical entity. We hope to alert the clinician to a relatively unknown source of recurrent headaches, that may be readily treated by otolaryngologists.

scholarly journals Large Doubly Septated Concha Bullosa: An Unusual Anatomic Variation

2009 ◽  
Vol 52 (3) ◽  
pp. 129-131 ◽  
Author(s):  
Aleksandar Perić ◽  
Svjetlana Matković-Jožin ◽  
Nenad Baletić
Keyword(s):  
Nasal Obstruction ◽  
Rare Case ◽  
Anatomic Variation ◽  
Middle Turbinate ◽  
Lateral Nasal Wall ◽  
Middle Meatus ◽  
Anatomic Variations ◽  
Concha Bullosa ◽  
Frontal Recess ◽  
Different Sources

Partial or total pneumatization of the middle turbinate is called concha bullosa. It’s one of the most common anatomic variations of the lateral nasal wall. The exact reason of such pneumatization is not known. It can originate from the frontal recess, middle meatus, sinus lateralis or, less frequently, from the posterior ethmoid cells. Concha bullosa remains usually asymptomatic. However, an extensively pneumatized middle turbinate may constitute space-occupying mass, and thus, it may cause nasal obstruction. We report an extremely rare case of a patient with a large, doubly septated concha bullosa with four different sources of aeration.

scholarly journals Maxillary sinusitis developed as sequelae of accidental middle turbinectomy that occurred during nasotracheal intubation: a case report

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Joungmin Kim ◽  
Taehee Pyeon ◽  
Hyun Jung Lee ◽  
Hyung Chae Yang
Keyword(s):  
Computed Tomography ◽  
Maxillary Sinusitis ◽  
Nasotracheal Intubation ◽  
Middle Turbinate ◽  
Orotracheal Intubation ◽  
Late Complications ◽  
Lateral Nasal Wall ◽  
Dental Surgery ◽  
Tube Obstruction

Abstract Background Nasotracheal intubation is a very useful technique for orofacial or dental surgery. However, the technique itself can be more traumatic than that of orotracheal intubation. Complications such as turbinectomy or bleeding are often reported. However, little is known about the follow-up of patients after these complications. Case presentation The present case describes an accidental middle turbinectomy that led to endotracheal tube obstruction during nasotracheal intubation, and discusses its long-term follow-up. A 19-year-old man underwent mandibular surgery under general anesthesia and nasotracheal intubation. His right middle turbinate was completely avulsed and became firmly occluded within the tube during nasotracheal intubation. The nasotracheal intubation was performed again and the operation was completed safely. The patient was discharged without sequelae after postoperative care. However, he had symptoms of nasal obstruction and sleep disturbance for 3 months postoperatively. Synechiae were detected between the nasal septum and lateral nasal wall on a right rhinoscopic examination and facial computed tomography at 3 months postoperatively. Additionally, he showed ipsilateral maxillary sinusitis on facial computed tomography at the 2-year follow-up examination. Conclusions Nasotracheal intubation can cause late complications as well as early complications. Therefore, if nasotracheal intubation is to be performed, the anesthesiologist should identify the nasal anatomy of the patient accurately and prepare appropriately. In addition, if complications occur, follow-up observation should be performed.

scholarly journals Mucopyocele of Concha Bullosa: A Rare Presentation as Orbital Swelling

2016 ◽  
Vol 8 (2) ◽  
pp. 53-55
Author(s):  
Hitendra Prakash Singh ◽  
Anupriya Hajela ◽  
Satya P Agarwal
Keyword(s):  
Thin Shell ◽  
Cystic Lesion ◽  
Middle Turbinate ◽  
Nasal Discharge ◽  
Concha Bullosa ◽  
Lacrimal Sac ◽  
Medial Aspect ◽  
Medial Canthus ◽  
Rare Presentation

ABSTRACT Whenever there is pneumatization of either turbinate, it is known as concha bullosa (CB). In the case of middle turbinate, it is the most common anatomical aberration. A mucopyocele of CB is very rarely seen. A 13-year-old male presented with the complaints of gradually progressive swelling on medial aspect of right eye with nasal obstruction, nasal discharge, and facial heaviness for 3 years. Computed tomography (CT) scan of the paranasal sinuses showed a well-defined cystic lesion of thick fluid attenuation with thin shell in the periphery located at the medial canthus of right eye involving the lacrimal sac region with stranding of adjacent periorbital fat plane. Lesion is seen causing erosion of lamina papyracea. After complete hematological and preanesthetic assessment, surgery was planned for the patient under general anesthesia. The lateral lamella and inferior part of CB was excised to drain out the pus and prevent recurrences. Patient remained symptom free in the follow-up period. How to cite this article Singh HP, Kumar S, Hajela A, Agarwal SP. Mucopyocele of Concha Bullosa: A Rare Presentation as Orbital Swelling. Int J Otorhinolaryngol Clin 2016;8(2):53-55.

scholarly journals Turbinoplasty of concha bullosa: a useful adjunct in improving nasal airway

2020 ◽  
Vol 6 (5) ◽  
pp. 878
Author(s):  
Nithya Venkataramani ◽  
Ravi Sachidananda ◽  
Srividya Rao Vasista
Keyword(s):  
Middle Turbinate ◽  
Added Value ◽  
Symptom Improvement ◽  
Nasal Airway ◽  
Middle Meatus ◽  
Concha Bullosa ◽  
Hospital Database ◽  
Nasal Symptoms ◽  
The Mean

<p class="abstract"><strong>Background:</strong> Concha bullosa is the pneumatisation of middle turbinate which causes crowding and obstruction of the middle meatus. This is associated with contralateral septal deviation. The objective of this study is to evaluate, if a concha bullosa turbinoplasty has any added value in improving nasal symptoms when performed as adjunct with septoplasty.</p><p class="abstract"><strong>Methods:</strong> Retrospective analysis of the hospital database was done and details of patients who underwent septoplasty along with concha bullosa turbinoplasty was collected and the patients were telephonically contacted to record their symptom improvement.  </p><p class="abstract"><strong>Results:</strong> Details of nineteen patients who underwent concha bullosa turbinoplasty with septoplasty were studied, mean age of the patients was 31.26 years and the mean follow up period was 22 months. All patients had improvement in symptoms with most completely asymptomatic, the others had mild to moderate symptoms.</p><p class="abstract"><strong>Conclusions:</strong> Concha bullosa turbinoplasty as an adjunct to septoplasty does alleviate the symptom of nasal obstruction.</p>

Posterior Pedicle Lateral Nasal Wall Flap: New Reconstructive Technique for Large Defects of the Skull Base

2011 ◽  
Vol 25 (6) ◽  
pp. e212-e216 ◽  
Author(s):  
Carlos M. Rivera-Serrano ◽  
Luis H. Bassagaisteguy ◽  
Gustavo Hadad ◽  
Ricardo L. Carrau ◽  
Dan Kelly ◽  
...  
Keyword(s):  
Skull Base ◽  
Clinical Experience ◽  
Sella Turcica ◽  
Pedicled Flap ◽  
Lateral Nasal Wall ◽  
Pedicle Flap ◽  
Early Clinical Experience ◽  
Clinical Scenarios ◽  
Skull Base Defects ◽  
Cadaveric Model

Background Indications for expanded endoscopic approaches continue to grow, resulting in larger and more complex skull base defects. Reconstructive developments, however, have lagged our extirpative capabilities. As the complexity of clinical scenarios continues to escalate, challenging our current reconstructive strategies, we are compelled to develop alternative techniques to prevent cerebrospinal fluid leaks and protect neurovascular structures. In this article we show the anatomic basis for a new posterior pedicled flap from the lateral wall of the nose (Carrau-Hadad [C-H] flap) for the reconstruction of median skull base defects and present our early clinical experience. Methods Using a cadaveric model, we designed a posterior pedicle flap comprising the nasal inferolateral wall mucoperiosteum. We applied this information clinically, to reconstruct transmural skull base defects. Results In our cadaveric model, we harvested and transposed C-H flaps into various defects of the planum sphenoidale, sella turcica, clivus, and nasopharynx. Then, we used the C-H flap in four patients, successfully reconstructing their clival (n = 3) and sellar (n = 1) surgical defects. All patients healed uneventfully. Conclusion Our anatomic study and early clinical experience support the use of the posterior pedicle lateral nasal wall flap to reconstruct large cranial base defects resulting from endoscopic skull base surgery in properly selected patients.

scholarly journals Bilateral Triple Concha Bullosa: A Very Rare Anatomical Variation of Intranasal Turbinates

2014 ◽  
Vol 2014 ◽  
pp. 1-2 ◽  
Author(s):  
Turhan San ◽  
Selma San ◽  
Emre Gürkan ◽  
Barış Erdoğan
Keyword(s):  
Paranasal Sinus ◽  
Anatomic Variation ◽  
Anatomical Variation ◽  
Middle Turbinate ◽  
Etiologic Factor ◽  
Lateral Nasal Wall ◽  
Concha Bullosa ◽  
Superior Turbinate ◽  
Negative Effect ◽  
Air Cells

Pneumatization of the intranasal turbinates or concha bullosa is an anatomic variation of the lateral nasal wall. Concha bullosa is defined as the presence of air cells in turbinates. It can be best diagnosed with paranasal sinus computed tomography. Concha bullosa is a possible etiologic factor for recurrent sinusitis due to its negative effect on paranasal sinus ventilation and mucociliary clearance. Concha bullosa is most commonly seen in the middle turbinate and less frequently in the inferior or superior turbinate. Pneumatization of all turbinates is very rare. To our knowledge, there are only two publications about a case with concha bullosa in all turbinates in the current literature. Here, we present a woman with bilateral pneumatization in all three intranasal turbinates.

Gamma knife radiosurgery as a single treatment modality for large cerebral arteriovenous malformations

2000 ◽  
Vol 93 (supplement_3) ◽  
pp. 113-119 ◽  
Author(s):  
D. Hung-Chi Pan ◽  
Wan-Yuo Guo ◽  
Wen-Yuh Chung ◽  
Cheng-Ying Shiau ◽  
Yue-Cune Chang ◽  
...  
Keyword(s):  
Gamma Knife ◽  
Arteriovenous Malformations ◽  
Radiation Treatment ◽  
Gamma Knife Radiosurgery ◽  
Consecutive Series ◽  
Content Type ◽  
Obliteration Rate ◽  
Complete Obliteration ◽  
Fine Print

Object. A consecutive series of 240 patients with arteriovenous malformations (AVMs) treated by gamma knife radiosurgery (GKS) between March 1993 and March 1999 was evaluated to assess the efficacy and safety of radiosurgery for cerebral AVMs larger than 10 cm3 in volume. Methods. Seventy-six patients (32%) had AVM nidus volumes of more than 10 cm3. During radiosurgery, targeting and delineation of AVM nidi were based on integrated stereotactic magnetic resonance (MR) imaging and x-ray angiography. The radiation treatment was performed using multiple small isocenters to improve conformity of the treatment volume. The mean dose inside the nidus was kept between 20 Gy and 24 Gy. The margin dose ranged between 15 to 18 Gy placed at the 55 to 60% isodose centers. Follow up ranged from 12 to 73 months. There was complete obliteration in 24 patients with an AVM volume of more than 10 cm3 and in 91 patients with an AVM volume of less than 10 cm3. The latency for complete obliteration in larger-volume AVMs was significantly longer. In Kaplan—Meier analysis, the complete obliteration rate in 40 months was 77% in AVMs with volumes between 10 to 15 cm3, as compared with 25% for AVMs with a volume of more than 15 cm3. In the latter, the obliteration rate had increased to 58% at 50 months. The follow-up MR images revealed that large-volume AVMs had higher incidences of postradiosurgical edema, petechiae, and hemorrhage. The bleeding rate before cure was 9.2% (seven of 76) for AVMs with a volume exceeding 10 cm3, and 1.8% (three of 164) for AVMs with a volume less than 10 cm3. Although focal edema was more frequently found in large AVMs, most of the cases were reversible. Permanent neurological complications were found in 3.9% (three of 76) of the patients with an AVM volume of more than 10 cm3, 3.8% (three of 80) of those with AVM volume of 3 to 10 cm3, and 2.4% (two of 84) of those with an AVM volume less than 3 cm3. These differences in complications rate were not significant. Conclusions. Recent improvement of radiosurgery in conjunction with stereotactic MR targeting and multiplanar dose planning has permitted the treatment of larger AVMs. It is suggested that gamma knife radiosurgery is effective for treating AVMs as large as 30 cm3 in volume with an acceptable risk.

Outcomes and Postoperative Complications of Robot-Assisted Laparoscopic Hysterosacropexy: Initial Experience

2015 ◽  
Vol 95 (1) ◽  
pp. 44-49 ◽  
Author(s):  
Maria Angela Cerruto ◽  
Carolina D'Elia ◽  
Francesca Maria Cavicchioli ◽  
Stefano Cavalleri ◽  
Matteo Balzarro ◽  
...  
Keyword(s):  
Uterine Prolapse ◽  
Pelvic Organ ◽  
Consecutive Series ◽  
Complication Rates ◽  
Early Complications ◽  
Robot Assisted ◽  
Female Patients ◽  
The Mean ◽  
Record Review

Background: Pelvic organ prolapse is a common condition, affecting about 50% of women with children. The aim of our study was to evaluate results and complication rates in a consecutive series of female patients undergoing robot-assisted laparoscopic hysterosacropexy (RALHSP). Materials and Methods: We performed a medical record review of female patients with uterine prolapse who had consecutively undergone RALHSP from February 2010 to 2013 at our department. Results: Fifteen patients were included in the analysis. All patients had uterine prolapse stage ≥II and urodynamic stress urinary incontinence. The mean age was 58.26 years. According to the Clavien-Dindo system, 4 out of 15 patients (26.6%) had grade 1 early complications and 1 patient had a grade 2 complication. At a median follow-up of 36 months, there was a significant prolapse relapse rate of 20% (3/15). Conclusion: In our hands RALHSP is easy to perform, with satisfying mid-term outcomes and a low complication rate.

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