scholarly journals Incidence of concha bullosa and its role in chronic rhinosinusitis

Author(s):  
Yalagandula Vijaya Lakshmi ◽  
Thakur Dinesh Singh ◽  
Razia Fathima ◽  
Vaddi Hemanth Kumar

<p class="abstract"><strong>Background:</strong> 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.</p><p class="abstract"><strong>Methods:</strong> 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.</p><p class="abstract"><strong>Results:</strong> Our study showed 54% cases of chronic sinusitis with concha bullosa.</p><p class="abstract"><strong>Conclusions:</strong> 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.</p>

Author(s):  
Niranjan Sahu ◽  
Satya Sundar G. Mohapatra ◽  
Siba N. Rath ◽  
Rabindra N. Padhy

Background: Recurrent acute rhinosinusitis (RARS), a low form chronic rhinosinusitis is frequently under evaluated. The significance of sinonasal anatomical variants of osteomeatal complex (OMC) and spheno-ethmoidal (SE) recess regions in patients of RARS is assessed.Methods: Retrospective analysis of coronal sinonasal computed tomography images of 120 RARS patients presented with sinonasal anatomical variants during November 2013 to October 2016 was carried out. Patients with acute and expansile sinonasal lesions are excluded.Results: Sinonasal anatomical variants in the regions of OMC and SE recess are responsible for obstruction of normal mucociliary drainage of corresponding paranasal sinuses in presence of inflammation predisposing to RARS. Anatomical variants of nasal septum were, deviated nasal septum (DNS) in 86 (72%) and septal spur in 58 (48%) patients. Anatomical variants in OMC region were, pneumatized middle turbinate (concha bullosa) in 50 (48%), paradoxical middle turbinate in 38 (28%), giant ethmoid bulla in 35 (32%), agger nasi cell in 29 (38%), Haller cell in 23 (15%), pneumatised uncinate process in 20 (18%), medialized uncinate process in 18 (22%) and septated maxillary sinus in 5 (4%) patients. Anatomical variants in SE recess were superior concha bullosa in 14 (12%) and septal bullosa in 11 (9%) patients.Conclusions: OMC pattern of recurrent rhinosinusitis is often prevalent in patients of RARS due to abundance of anatomical variants in the OMC region. DNS or ethmoid bulla when gets associated with concha bullosa increased the incidence of RARS. Present analysis would help surgeons to evaluate RARS patients for selective endoscopic sinus surgery.


Author(s):  
Pragadeeswaran Kumarasekaran ◽  
Rajprakash Dharmapuri Yadhava krishnan ◽  
Gurumani Sriraman

<p class="abstract"><strong>Background:</strong> <span lang="EN-IN">C</span><span lang="EN-IN">hronic 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. </span></p><p class="abstract"><strong>Methods:</strong> <span lang="EN-IN">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.  </span></p><p class="abstract"><strong>Results:</strong> <span lang="EN-IN">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. </span></p><p class="abstract"><strong>Conclusions:</strong> <span lang="EN-IN">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.<strong> </strong>Deviated nasal septum is the most common anatomical variation in our study followed by concha bullosa, medialized uncinate process.</span></p>


1998 ◽  
Vol 5 (1) ◽  
pp. 1-8
Author(s):  
T. D. Morre ◽  
P. A. R. Clement ◽  
G. Noussios

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.


2018 ◽  
Vol 32 (2) ◽  
pp. 98-100
Author(s):  
Ryan H. Belcher ◽  
Allison K. Ikeda ◽  
John M. DelGaudio

Background Endoscopic sinus surgery is performed for many reasons, most commonly for chronic rhinosinusitis refractory to medical treatment. A paradoxical middle turbinate is an anatomic variant that can hinder endoscopic access to the sinuses. No publication has addressed how to surgically treat a paradoxical middle turbinate. Method We present a basic endoscopic surgical approach to conservatively resect a paradoxical middle turbinate in order to improve access to the middle meatus and the sinuses while preserving support and function. Conclusion Conservative remodeling of the paradoxical middle turbinate can provide access to the sinuses while maintaining a significant portion of the middle turbinate.


2020 ◽  
Vol 277 (11) ◽  
pp. 3079-3089
Author(s):  
Meichan Zhu ◽  
Yongyi Yan ◽  
Huicheng Gong ◽  
Yunwen Wu ◽  
Guojie Tan

2019 ◽  
Vol 34 (2) ◽  
pp. 162-169
Author(s):  
Jesse R. Qualliotine ◽  
Aria Jafari ◽  
Sarek Shen ◽  
Jeffrey D. Bernstein ◽  
Adam S. DeConde

Background Concha bullosa (CB) is a prevalent anatomic variant and frequent surgical target in endoscopic sinus surgery (ESS). However, whether CB impacts quality-of-life (QOL) in chronic rhinosinusitis (CRS) is not well established. The purpose of this study was to investigate baseline and post-ESS QOL differences in patients with medically recalcitrant CRS with and without CB. Methods Demographic and surgical characteristics, baseline and postoperative 22-item Sino-Nasal Outcome Test (SNOT-22) scores for 137 patients with CRS who underwent primary ESS at our institution were recorded. Computed tomography (CT) scans were reviewed for Lund–Mackay score and presence of CB. Multiplanar CT was used to measure CB dimensions and estimate volume. Multivariable analysis was performed to identify differences in SNOT-22 overall and symptom-domain scores between patients with upper quartile (≥0.8 mL) CB and without CB. Results CB was found in 37% of patients with mean volume of 0.67 mL. There were no significant differences in distribution of clinicodemographic variables by large CB status. At baseline, large CB was associated with higher SNOT-22 extranasal-rhinologic domain score (9.8 vs 6.0, P < .01). Following ESS, patients with large CB reported greater improvement in SNOT-22 extranasal-rhinologic domain score (multivariable mean absolute improvement 3.8, P = .01; relative 56% vs 30%). Conclusion Patients with medically recalcitrant CRS and concomitant large CB have higher SNOT-22 extranasal-rhinologic domain scores at baseline, but also report greater intradomain improvement exceeding the subdomain’s mean clinically important difference. To our knowledge, this is the first demonstration that CB has a clinically significant impact on QOL in CRS, and surgical intervention may be helpful to address these symptoms.


2016 ◽  
Vol 9 (1) ◽  
pp. 28-32 ◽  
Author(s):  
V Narendrakumar ◽  
V Subramanian

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.


1996 ◽  
Vol 10 (4) ◽  
pp. 211-216 ◽  
Author(s):  
P. L. Larsen ◽  
M. Tos

Systematic examination of the paranasal sinuses and nasal cavity followed by endoscopic endonasal surgery was performed in 31 cadavers, polyps being found in 13. In all, a total of 27 polyps was found. Only four patients had a case history of allergy or sinusitis. The polyps and their place of origin were documented photographically. A total of 70% of the polyps originated in the ostia, clefts, or recesses. In three patients, polyps originated on the middle turbinate, and in one the agger nasi area, indicating that polyp formation in the ethmoidal sinuses and other paranasal sinuses is secondary to the formation of polyps in the sinus ostia, clefts, and recesses.


2013 ◽  
Vol 127 (4) ◽  
pp. 419-422 ◽  
Author(s):  
K Tsioulos ◽  
M Martinez Del Pero ◽  
C Philpott

AbstractObjective:To describe a rare case of multiple anatomical variations in the sinonasal skeleton of an adolescent with chronic rhinosinusitis, together with its successful surgical management.Case report:A 15-year-old male adolescent was referred with a 3-year history of nasal blockage and hyposmia. His symptoms did not improve on maximal medical therapy. A pre-operative computed tomography scan revealed numerous anatomical variations in his nose and paranasal sinuses. He underwent neuronavigation-assisted endoscopic sinus surgery without complication, and with subsequent resolution of his symptoms at 10 months.Conclusion:Chronic rhinosinusitis in children offers its own set of unique surgical challenges. The effectiveness and safety of sinus surgery in this population can be improved through the knowledge of anatomical variants, and is aided by the use of image guidance systems.


1998 ◽  
Vol 118 (6) ◽  
pp. 800-803 ◽  
Author(s):  
JOSEPH M. BERNSTEIN ◽  
RICHARD A. LEBOWITZ ◽  
JOSEPH B. JACOBS

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.


Sign in / Sign up

Export Citation Format

Share Document