Concha Bullosa in Paradoxical Middle Turbinate: A New Variation

ABSTRACT Introduction Concha bullosa is the most common anatomic variation of osteomeatal complex region that is generally seen in the middle turbinate (MT). Materials and methods A 25-year-old male presented with headache and nasal obstruction. Computed tomography (CT) scan documented right paradoxical MT. The right MT also showed aerated concha bullosa with narrow right osteomeatal area. Routine preoperative laboratory tests were within normal limits. Results This case of concha bullosa in paradoxically bent MT was reported, described, and could be safely managed endoscopically. Patient was symptom free up to date without any complication, recurrence, or other pathology. Conclusion Computed tomography may easily identify such uncommon anatomic variations of the osteomeatal region. This directs the surgeon attention to these variations as a cause of headache and osteomeatal area obstruction. How to cite this article El-Anwar MW, Ali AI. Concha Bullosa in Paradoxical Middle Turbinate: A New Variation. Clin Rhinol An Int J 2016;9(3):141-142.

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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.

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Large Doubly Septated Concha Bullosa: An Unusual Anatomic Variation

Acta Medica (Hradec Kralove Czech Republic) ◽

10.14712/18059694.2016.118 ◽

2009 ◽

Vol 52 (3) ◽

pp. 129-131 ◽

Cited By ~ 2

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.

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An unusual location for a fungus ball: the concha bullosa

The Journal of Laryngology & Otology ◽

10.1017/s0022215112001247 ◽

2012 ◽

Vol 126 (8) ◽

pp. 844-846 ◽

Cited By ~ 12

Author(s):

E Ciger ◽

U Demiray ◽

K Onal ◽

M Songu

Keyword(s):

Computed Tomography ◽

Unusual Case ◽

Histopathological Examination ◽

Middle Turbinate ◽

Fungus Ball ◽

Concha Bullosa ◽

Healthy Individuals ◽

Non Invasive ◽

The Right ◽

Fungus Balls

AbstractObjective:We report an unusual case of a fungus ball in the concha bullosa, without involvement of the paranasal sinuses.Case report:A 29-year-old woman presented complaining of nasal obstruction and postnasal discharge. Paranasal computed tomography demonstrated that the concha bullosa in the right middle turbinate was filled with a high-density material. The patient underwent endoscopic resection of the concha bullosa, during which a dark brown, cheese-like material was found. Histopathological examination of the excised specimen revealed a fungus ball.Conclusion:Fungus balls are non-invasive accumulations of dense fungal concretions that generally affect healthy individuals. In the sinonasal region, they occur most frequently in the maxillary sinus. Although fungus ball formation in the concha bullosa is unusual, it should be considered in the differential diagnoses of middle turbinate and sinonasal pathology.

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Concha bullosa and the nasal middle meatus obstructive syndrome

Vojnosanitetski pregled ◽

10.2298/vsp0803255p ◽

2008 ◽

Vol 65 (3) ◽

pp. 255-258 ◽

Cited By ~ 5

Author(s):

Aleksandar Peric ◽

Jelena Sotirovic ◽

Nenad Baletic ◽

Ruzica Kozomara ◽

Dusan Bijelic ◽

...

Keyword(s):

Nasal Cavity ◽

Anatomic Variation ◽

Middle Turbinate ◽

Common Symptom ◽

Middle Meatus ◽

Concha Bullosa ◽

Nasal Breathing ◽

Nasal Cycle ◽

Important Symptom ◽

The Right

Background. Concha bullosa (CB) is pneumatization of the middle turbinate and one of the most common anatomic variation of the sinonasal region. It is found in about 25% of the population. Middle meatus obstructive syndrome (MMOS) is, usually connected with CB. The main symptoms of this syndrome are headaches, impaired nasal breathing and hyposmia. Headache is the most common symptom and it may occur due to contact between a CB and other structures of the nasal cavity. Case report. We presented a case of 32 year-old-woman with headaches, located in the orbital and the left frontal region. The headaches were intermittent and corresponding to the nasal cycle. After neurologic and alergic examination, endoscopic nasal examination demonstrated a septal deviation to the right side and a large middle turbinate in the left side of the nasal cavity. Coronal computerized tomography (CT) of the paranasal sinuses demonstrated the septal deformation and pneumatization of the left middle turbinate. Diagnosis was confirmed by lidocaine test. In the functional endoscopic surgery (FESS), the lateral lamela of the anterior CB was removed. At the same time, the septoplasty was done. At the control examination, the patient was without symptoms. Conclusion. Although CB is the common anatomic variation of the nasal cavity, MMOS is rare. Headache (rhinogenic origin) is the most important symptom. Surgical treatment is the lateral resection of the CB in the FESS technique and the septoplasty.

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A computed tomography and endoscopy assisted study of the anatomical variations of lateral wall of nose in patients of chronic rhinosinusitis- our experience at a tertiary care centre

International Journal of Otorhinolaryngology and Head and Neck Surgery ◽

10.18203/issn.2454-5929.ijohns20171187 ◽

2017 ◽

Vol 3 (2) ◽

pp. 327

Author(s):

Shashidhar S. Suligavi ◽

Afshan Fathima ◽

Mallikarjun N. Patil ◽

S. S. Doddamani

Keyword(s):

Computed Tomography ◽

Ct Scan ◽

Chronic Rhinosinusitis ◽

Task Force ◽

Anatomic Variation ◽

Intraoperative Complications ◽

Tertiary Care ◽

Middle Turbinate ◽

Lateral Wall ◽

Anatomical Variations

Background: Chronic rhinosinusitis (CRS) is a common and persistent illness that ENT surgeons encounter in their day to day practice. The lateral wall of the nose contains the ostiomeatal unit which is the key area targeted in the management of CRS. The lateral wall of nose shows several variations which can alter the course of the disease. It is of utmost importance for the ENT surgeon to be aware of these variations as they decide the overall line of management. The objectives of the study was to study the anatomical variations of the lateral wall of nose using computed tomography (CT) scans and nasal endoscopy in patients of chronic rhinosinusitis.Methods: A one year study from April 2015 to March 2016 involving 50 patients attending the ENT outpatient department clinically diagnosed as CRS using the criteria of task force on rhinosinusitis were included in the present study. Patients underwent a CT scan and DNE and the anatomical variations of the lateral wall of nose were studied. Results: Concha bullosa was the most common anatomic variation noted in 20 (40%) of the total 50 patients. The other anatomic variations noted were uncinate process variations in 15(30%) patients, agger nasi cells in 3 (6%) patients, hypoplastic middle turbinate in 1 (2%) patient, paradoxical middle turbinate in 2(4%) patients, bulla ethmoidalis in 4 (8%) patients and Haller cells in 1 (2%) patient. Conclusions: The lateral wall of nose is made up of several structures showing variations which can lead to the development CRS and affect the overall management. They should be evaluated pre-operatively in order to avoid intraoperative complications. CT scan and DNE both complement each other and effectively evaluate the anatomical variations of the lateral wall of nose.

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The prevalence of middle turbinate pneumatization in patients of Southern region of Saudi Arabia

International Journal of Otorhinolaryngology and Head and Neck Surgery ◽

10.18203/issn.2454-5929.ijohns20212442 ◽

2021 ◽

Vol 7 (7) ◽

pp. 1092

Author(s):

Musleh Mubaraki ◽

Radeif Shamakhi ◽

Ramzi Dighriri ◽

Ali Alzarei

Keyword(s):

Computed Tomography ◽

Saudi Arabia ◽

Differential Diagnosis ◽

Middle Turbinate ◽

Southern Region ◽

Ct Scans ◽

Concha Bullosa ◽

Number Of Patients ◽

Computed Tomography Scans ◽

The Right

Background: The aim of the study was to determine the prevalence of middle turbinate pneumatization in patients of Southern region of Saudi Arabia. Methods: This study used a retrospective radiological design to analyze computed tomography scans of 117 patients aged between 18 and 80 years of Southern region in Saudi Arabia were used in this study. Patients with altered anatomy (iatrogenic or pathological) were excluded, CT scans were analysed to determine the prevalence of middle turbinate pneumatization in patients of Southern region of Saudi Arabia. Results: There were forty percent (40%) male cases and sixty percent (60%) female cases. Concha bullosa (CB) was discovered in 17 (14.5%) of the cases, with 4 cases (23%) being bilateral and 13 (76%) being unilateral. 7 (53%) of unilateral cases were on the right side, while 6 (47%) were on the left.Conclusions: CB was discovered in 17 (14.5%) of the cases, in patients of Southern region of Saudi Arabia, most of them unilateral by 76%. That’s indicate there is significant number of patients have CB and surgeon should consider it one of his differential diagnosis in patient with nasal obstruction.

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Delayed Extradural Hematoma after Evacuation of Contralateral Acute Extradural Hematoma

Indian Journal of Neurotrauma ◽

10.1055/s-0040-1713722 ◽

2020 ◽

Author(s):

Majid Anwer ◽

Atique Ur Rehman ◽

Farheen Ahmed ◽

Satyendra Kumar ◽

Md Masleh Uddin

Keyword(s):

Computed Tomography ◽

Ct Scan ◽

Postoperative Period ◽

Road Traffic ◽

Case Reports ◽

Mass Effect ◽

Extradural Hematoma ◽

Traumatic Head Injury ◽

Neurologic Deterioration ◽

The Right

Abstract Introduction Traumatic head injury with extradural hematoma (EDH) is seen in 2% of patients. Development of EDH on the contralateral side is an uncommon complication that has been reported in various case reports. Case Report We report here a case of an 18-year-old male who had a road traffic injury. He was diagnosed as a case of left-sided large frontotemporoparietal acute extradural bleed with a mass effect toward the right side. He was managed with urgent craniotomy and evacuation of hematoma. A noncontrast computed tomography (NCCT) scan performed 8 hours after postoperative period showed a large frontotemporoparietal bleed on the right side with a mass effect toward the left side. He was again taken to the operating room and right-sided craniotomy and evacuation of hematoma were performed. A postoperative NCCT scan revealed a resolved hematoma. The patient made a complete recovery in the postoperative period and is doing well. Conclusion Delayed onset epidural hematoma is diagnosed when the initial computed tomography (CT) scan is negative or is performed early and when late CT scan performed to assess clinical or ICP deterioration shows an EDH. The diagnosis of such a condition requires a high index of suspicion based on the mechanism of injury along with fracture patterns. Additionally, change in pupillary size, raised intracranial pressure, and bulging of the brain intraoperatively are additional clues for contralateral bleeding. Neurologic deterioration may or may not be associated with delayed EDH presentation. An early postoperative NCCT scan within 24 hours is recommended to detect this complication with or without any neurologic deterioration.

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

Avicenna Journal of Dental Research ◽

10.34172/ajdr.2020.19 ◽

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).

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Development of a fully automatic deep learning system for L3 selection and body composition assessment on computed tomography

Scientific Reports ◽

10.1038/s41598-021-00161-5 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Jiyeon Ha ◽

Taeyong Park ◽

Hong-Kyu Kim ◽

Youngbin Shin ◽

Yousun Ko ◽

...

Keyword(s):

Computed Tomography ◽

Anatomic Variation ◽

External Validation ◽

Abdominal Muscle ◽

Anatomic Variations ◽

Success Rates ◽

Technical Success ◽

Segmentation Accuracy ◽

Distance Difference ◽

Fully Automatic

AbstractAs sarcopenia research has been gaining emphasis, the need for quantification of abdominal muscle on computed tomography (CT) is increasing. Thus, a fully automated system to select L3 slice and segment muscle in an end-to-end manner is demanded. We aimed to develop a deep learning model (DLM) to select the L3 slice with consideration of anatomic variations and to segment cross-sectional areas (CSAs) of abdominal muscle and fat. Our DLM, named L3SEG-net, was composed of a YOLOv3-based algorithm for selecting the L3 slice and a fully convolutional network (FCN)-based algorithm for segmentation. The YOLOv3-based algorithm was developed via supervised learning using a training dataset (n = 922), and the FCN-based algorithm was transferred from prior work. Our L3SEG-net was validated with internal (n = 496) and external validation (n = 586) datasets. Ground truth L3 level CT slice and anatomic variation were identified by a board-certified radiologist. L3 slice selection accuracy was evaluated by the distance difference between ground truths and DLM-derived results. Technical success for L3 slice selection was defined when the distance difference was < 10 mm. Overall segmentation accuracy was evaluated by CSA error and DSC value. The influence of anatomic variations on DLM performance was evaluated. In the internal and external validation datasets, the accuracy of automatic L3 slice selection was high, with mean distance differences of 3.7 ± 8.4 mm and 4.1 ± 8.3 mm, respectively, and with technical success rates of 93.1% and 92.3%, respectively. However, in the subgroup analysis of anatomic variations, the L3 slice selection accuracy decreased, with distance differences of 12.4 ± 15.4 mm and 12.1 ± 14.6 mm, respectively, and with technical success rates of 67.2% and 67.9%, respectively. The overall segmentation accuracy of abdominal muscle areas was excellent regardless of anatomic variation, with CSA errors of 1.38–3.10 cm2. A fully automatic system was developed for the selection of an exact axial CT slice at the L3 vertebral level and the segmentation of abdominal muscle areas.

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

The Journal of Laryngology & Otology ◽

10.1017/s0022215120000444 ◽

2020 ◽

Vol 134 (4) ◽

pp. 328-331 ◽

Cited By ~ 1

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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