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

Abstract

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.

The relationship between septal deviation and concha bullosa

“…In the present study examining the Combination of multiple types (1)(2)(3)(4)(5)(6) correlation between the types of septal deviation and concha bullosa, the incidence of concha bullosa was higher in patients with type 3 septal deviation. This finding suggests that the type of septal deviation, defined according to localization and degree of deviation, may have a role in the development of concha bullosa.…”

“…It may caused by the expansion of sinus pneumatization into the turbinate during the intrauterine period, fusion abnormality during intrauterine development or mucosal invagination of conchal bone microfractures toward the bullosa cavity during late puberty. [4] Another theory suggests that anterior and posterior ethmoidal air cells lead to pneumatization of concha bullosa.…”

“…[3] Nasal turbinates are structures maintaining nasal functions of humidification, lubrication, olfaction, filtration and thermoregulation. [4] Concha bullosa or pneumatized middle turbinate is the most common anatomic variant of the middle turbinate (14-53.6%) and is diagnosed on computed tomography (CT). [5,6] This finding has become clearer on CT scans that have gained more use in preoperative evaluation.…”

The incidence of pneumatised inferior turbinate and relation to close anatomic structures

“…The secondary theory focuses on the possible role of the maxillary sinus disease and its close relation to the traction zone of the inferior turbinate [7]. The third theory suggests that the extension of the ventilation of the maxillary sinus to the inferior concha in the foetal life may result in PIT [11,15].…”

“…Depending on the similarity of the epithelium in the air gaps between the conchae and other sinusal cavities, similar inflammatory diseases may accompany pneumatisation [3]. In addition to that, over-ventilated conchae may form mass effect and cause the obstruction in the nasal cavity and sinus infections by affecting osteomeatal drainage [11]. In the study of Baldea et al [1], 8 of 10 pneumatised cases had symptoms of rhinosinusal infection.…”