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.

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.

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 Concha Bullosa Osteoma: An Unusual Cause of Headache

2017 ◽  
Vol 10 (1) ◽  
pp. 25-27
Author(s):  
Pragya Singh ◽  
Mahesh K Mittal ◽  
Neeraj N Mathur ◽  
Mukul Sinha
Keyword(s):  
Facial Pain ◽  
Multislice Computed Tomography ◽  
Preoperative Planning ◽  
Middle Turbinate ◽  
Benign Tumors ◽  
Surgical Removal ◽  
Concha Bullosa ◽  
Rare Occurrence ◽  
Radiological Findings ◽  
Computed Tomography Scanner

ABSTRACT Aim and background Osteomas are common benign tumors of the paranasal sinuses, but are usually asymptomatic and found as a coincidental finding during routine radiological investigations. The aim is to demonstrate typical radiological findings of osteomas and demonstrate rare occurrence of osteoma in middle turbinate. Case report Patient presenting with recurrent headaches, left-sided facial pain, and intermittent nasal obstruction was evaluated using Philips Brilliance 40-multislice computed tomography scanner, which showed bilateral maxillary and ethmoid sinusitis with bilateral fluid-filled concha bullosa with left-sided concha bullosa showing a well-defined lesion of bone attenuation suggestive of osteoma. Conclusion Osteomas can rarely occur in nasal turbinates and may be symptomatic requiring endoscopic/surgical removal. Clinical significance Radiological investigations are diagnostic for osteomas and play an important role in preoperative planning. Osteomas arising from the turbinates are more easily accessible by endoscopy than sinus osteomas; hence, removal carries less risk. Therefore, it is important to diagnose nasal osteoma when it is small in size, follow it up, and resect it when its size is appropriate for endoscopic surgery. How to cite this article Singh P, Mittal MK, Mathur NN, Sinha M. Concha Bullosa Osteoma: An Unusual Cause of Headache. Clin Rhinol An Int J 2017;10(1):25-27.

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.

Rhinologic Headaches

1994 ◽  
Vol 111 (3P1) ◽  
pp. 211-218 ◽  
Author(s):  
James M. Chow
Keyword(s):  
Surgical Therapy ◽  
Paranasal Sinuses ◽  
Facial Pain ◽  
Middle Turbinate ◽  
Infraorbital Nerve ◽  
Exclusion Criteria ◽  
Contact Points ◽  
Minimal Improvement ◽  
Septal Spur ◽  
Retention Cysts

From January 1, 1991, to June 30, 1992, 18 patients were identified as having rhinologic sources for their primary symptom of facial pain or headache. These 18 patients satisfied certain inclusion and exclusion criteria to identify the site of origin of the headaches or facial pains as coming from the nasal cavities or paranasal sinuses. The majority of these patients (12 patients) were determined to have a septal spur causing the facial pain or headache. Other identified causes included retention cysts (3 patients), mucosal contact points (2 patients), and a dehiscent infraorbital nerve (1 patient). Fifteen of these 18 patients (83%) were significantly improved or cured of their facial pain or headache after medical or surgical therapy. The 3 patients who had either a minimal improvement or no improvement in their facial pains or headaches included 1 patient with an area of mucosal contact between the middle turbinate and the bulla ethmoidalis and 2 patients with septal spurs. In summary, medical or surgical therapy can be beneficial in the treatment of patients with headaches or facial pains of rhinologic origin.

scholarly journals Evaluation of the Prevalence of Concha Bullosa in Cone-Beam Computed Tomography Images

2020 ◽  
Vol 12 (3) ◽  
pp. 93-96
Author(s):  
Nasim Shams ◽  
Bahareh Shams ◽  
Zahra Sajadi
Keyword(s):  
Computed Tomography ◽  
Cone Beam Computed Tomography ◽  
Middle Turbinate ◽  
Cone Beam ◽  
P Value ◽  
Concha Bullosa ◽  
Computed Tomography Images ◽  
Significant Difference ◽  
And Gender ◽  
Sinus Ostium

Background: The ostiomeatal complex (OMC) is not a separate anatomical structure although it is a functional unit of structures, including the middle meatus, uncinate process, infundibulum, maxillary sinus ostium, ethmoidal bulla, anterior ethmoid sinus ostium, and frontal recess. Concha bullosa is the pneumatization of the concha, which is one of the most common anatomical variations in the middle turbinate. Methods: This study was conducted using the cone-beam computed tomography (CBCT) images of 172 patients in the archives of the Department of Oral and Maxillofacial Radiology, Dentistry School, Ahvaz Jundishapur. Patient information including age and gender, presence or absence of concha bullosa, the involved side (left or right), and its type (i.e., extensive, lamellar, and bulbous) were collected in the information form. Finally, the chi-square test (with SPSS, version 22) was used to analyze the data, and P value less than 0.05 was considered statistically significant. Results: Patients with and without concha bullosa were 39.1 and 41.7 years, respectively, but it was no significant difference in terms of age (P = 0.321). Out of 52 patients with concha bullosa, 19 (36.5%) cases were males and 33 (63.5%) of them were females. The prevalence of concha bullosa was higher for the bilateral side (20 patients, 38.5%, P = 0.000). The prevalence of bulbulsand lamellar-shape was nearly the same (32.7% and 30.8%, respectively). Eventually, the extensive shape with 36.5% was more frequent for the shape of concha bullosa (P = 0.000). Conclusions: The prevalence of concha bullosa was high. There was no significant difference in terms of age (P = 0.321) and gender (P = 0.058) of patients with concha bullosa. The extensive type and the bilateral appearance of concha bullosa were more significant (P = 0.000).

Endoscopic Endonasal Approaches to the Cavernous Sinus: Surgical Approaches

Neurosurgery ◽  
2001 ◽  
Vol 49 (2) ◽  
pp. 354-362 ◽  
Author(s):  
Alessandra Alfieri ◽  
Hae-Dong Jho
Keyword(s):  
Cavernous Sinus ◽  
Middle Turbinate ◽  
Lateral Wall ◽  
Surgical Instruments ◽  
Surgical Approaches ◽  
Lateral Nasal Wall ◽  
Orbital Apex ◽  
Superior Orbital Fissure ◽  
Endoscopic Endonasal ◽  
Surgical Access

Abstract OBJECTIVE After completion of an earlier endoscopic transsphenoidal anatomic study, we studied various endoscopic transsphenoidal approaches using cadaveric specimens to develop endoscopic endonasal surgical approaches to the cavernous sinus. METHODS Ten cavernous sinuses in five artery-injected adult cadaveric heads were studied with 0-, 30-, and 70-degree angled 4-mm rod-lens endoscopes. The extent of the surgical exposure, the skewed endoscopic anatomic view, and the maneuverability of surgical instruments through their relative operating spaces were studied after various endoscopic endonasal approaches via one nostril. RESULTS The paraseptal approach was used between the nasal septum and the middle turbinate and provided exposure at the anteromedial portion of the cavernous sinus. The contralateral paraseptal approach rendered a slightly more medial view at the cavernous sinus than did the ipsilateral approach. This approach offered limited surgical access to the lateral vertical compartment. The middle turbinectomy approach allowed surgical access to the lateral wall of the cavernous sinus, except for the superior orbital fissure and the orbital apex. The middle meatal approach, which was made between the middle turbinate and the lateral nasal wall, revealed the entire lateral vertical compartment of the cavernous sinus, including the orbital apex and the superior orbital fissure. However, its lateral tangential surgical trajectory and the absence of dedicated surgical tools limited the surgeon's surgical maneuverability. A combination of the middle turbinectomy and middle meatal approaches increased the operating space. CONCLUSION Various endoscopic endonasal surgical approaches to the cavernous sinus were studied using adult cadaveric head specimens.

An artificial intelligence algorithm that identifies middle turbinate pneumatisation (concha bullosa) on sinus computed tomography scans

2020 ◽  
Vol 134 (4) ◽  
pp. 328-331 ◽  
Author(s):  
P Parmar ◽  
A-R Habib ◽  
D Mendis ◽  
A Daniel ◽  
M Duvnjak ◽  
...  
Keyword(s):  
Neural Network ◽  
Artificial Intelligence ◽  
Computed Tomography ◽  
Diagnostic Accuracy ◽  
Convolutional Neural Network ◽  
Middle Turbinate ◽  
Concha Bullosa ◽  
Computed Tomography Images ◽  
Computed Tomography Scans ◽  
Neural Network Algorithm

AbstractObjectiveConvolutional neural networks are a subclass of deep learning or artificial intelligence that are predominantly used for image analysis and classification. This proof-of-concept study attempts to train a convolutional neural network algorithm that can reliably determine if the middle turbinate is pneumatised (concha bullosa) on coronal sinus computed tomography images.MethodConsecutive high-resolution computed tomography scans of the paranasal sinuses were retrospectively collected between January 2016 and December 2018 at a tertiary rhinology hospital in Australia. The classification layer of Inception-V3 was retrained in Python using a transfer learning method to interpret the computed tomography images. Segmentation analysis was also performed in an attempt to increase diagnostic accuracy.ResultsThe trained convolutional neural network was found to have diagnostic accuracy of 81 per cent (95 per cent confidence interval: 73.0–89.0 per cent) with an area under the curve of 0.93.ConclusionA trained convolutional neural network algorithm appears to successfully identify pneumatisation of the middle turbinate with high accuracy. Further studies can be pursued to test its ability in other clinically important anatomical variants in otolaryngology and rhinology.

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