The effect of concha bullosa and nasal septal deviation on palatal dimensions: a cone beam computed tomography study

Introduction Nasal septal deviation (NSD) and concha bullosa (CB) are associated with airway obstruction in mouth breathers. Mouth breathing is associated with alterations in maxillary growth and palatal architecture. The aim of our study was to determine the effect of the presence of CB and NSD on the dimensions of the hard palate using cone-beam computed tomography (CBCT). Materials and methods A retrospective study was conducted using CBCT scans of 200 study subjects. The study subjects were divided into four groups based on the presence of CB and NSD. Septal deviation angle (SDA), palatal interalveolar length (PIL), palatal depth (PD) and maxillopalatal arch angle (MPAA) were measured in the study groups. Results The presence of NSD and CB was associated with significant (p < 0.001) differences in the palatal dimensions of the study subjects. The PIL and MPA (p < 0.001) were significantly reduced (p < 0.001), whereas the PD was significantly increased (p < 0.001) in study subjects with NSD and CB. There was no significant change in the palatal dimensions between the unilateral and bilateral types of CB. Among the palatal dimensions, the PIL had the most significant association (R2 = 0.53) with SDA and CB. There was a significant correlation between the palatal dimensions and SDA when CB was present along with NSD. Conclusion Based on the results of this study, it can be concluded that the presence of NSD and CB have a significant effect on the palatal dimensions and, therefore, they may be associated with skeletal malocclusion.

Incidental Finding of Bullous Concha by Cone Beam Computed Tomography

This study aimed to describe the imaging aspects of a concha bullosa discovered incidentally by means of cone-beam computed tomography (CBCT) imaging. A female patient underwent a CBCT exam, and a bilateral extensive pneumatization of the middle concha was verified, presenting a larger dimension of the right side and a deviated septum. The patient reported nasal obstruction and loss of smell. The CBCT for covering the maxillofacial region allowed the discovery of this incidental finding, allowing the patient to be referred for appropriate treatment.

Multi Detector Computed Tomographical Assessment of Anatomical Variants of Paranasal Sinuses

Multi detector computed tomography (MDCT) scan of paranasal sinuses has become mandatory for all patients undergoing functional endoscopic sinus surgery. It depicts the anatomical variations in much simpler way and acts as a roadmap for endoscopic sinus surgery. In this study the maximum of participants were in the age group of 41- 50 years (32 %). The mean age of the study participants was observed to be 43.8 ± 15.6 years. HRCT PNS results shows nasal septum was found to be the most common anatomical variant (DNS- 94%). Concha Bullosa in right side were seen in 37.5% and left side were 21.9% (total unilateral cases- 59.4%) and bilateral Concha Bullosa were seen in 40.6% of the cases. Agger nasi were found to be present in 58% of the CRS cases among which right AN was 41%, left side was 30.8%, and bilateral AN were seen in 28.2% of the cases and Paradoxical Middle Turbinate were seen in 42% of cases in our study. Medialised uncinate was seen in 22% of the cases.

Incidence of concha bullosa and its role in chronic rhinosinusitis

<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>

Prevalence of Maxillary Sinus Hypoplasia and Silent Sinus Syndrome: A Radiological Cross-Sectional Retrospective Cohort Study

Background Maxillary sinus hypoplasia (MSH), associated with enophthalmos and hypoglobus in the silent sinus syndrome (SSS), is a poorly studied condition. The real incidence of MSH and SSS in the adult population is not known. Our study aims at estimating the radiological prevalence of MSH and identifying undiagnosed cases of SSS in a retrospective cohort. Methods A cross-sectional retrospective cohort study was performed in adults, without a history of maxillofacial surgery or trauma, undergoing head CT scans. A radiological database of 1012 consecutive scans was reviewed independently by two authors to identify patients with signs of MSH and SSS and associated findings (septal deviation, uncinate deviation, concha bullosa, sinus opacification, bony rarefaction, and pterygopalatine fossa enlargement). The findings of MSH and SSS were compared with radiological reports. Results 891 eligible CT scans were analyzed. MSH and SSS prevalences were 6.17% (n = 55) and 0,56% (n = 5), respectively. The maxillary sinus was normally or partially ventilated in 96.36% of MSH patients. Lateralization of the uncinate process was detected in about 50% of MSH patients, while a septal deviation towards the affected sinus was detected in 21.82%. In 20% of MSH scans, a concha bullosa was identified. Radiological reports identified a single MSH case. Conclusions Our study confirmed the literature data on MSH prevalence, while it determined a precedently unknown prevalence for SSS, underestimated in the radiology reports. This prevalence needs further confirmation but suggests a routine accurate comparison of both maxillary sinuses in CT scans.

Mucocele of a giant inferior turbinate concha bullosa mimics a nasal mass: case report

Background The concha bullosa is a pneumatized nasal turbinate commonly middle turbinate but that of the inferior turbinate is an uncommon entity. A giant inferior conchal pneumatization with mucocele formation is not reported in the literature till now. Case presentation A 17-year-old female patient presented with bilateral severe nasal obstruction. Anterior rhinoscopy and endoscopic examination revealed a giant mass which filled the left nasal cavity completely, pushing the septum to the contralateral side. The paranasal sinus CT showed a mass in the left nasal cavity ballooning the whole nasal cavity with compression of the nasal septum to the right side. MRI was done and the lesion was hyperintense in T2 MRI sequences and hypointense in T1 sequences consistent with a cystic lesion. The patient was consented and prepared for endoscopic resection under general anesthesia. The lesion was completely separated from the nasal septum and the orbit but attached to the lateral nasal wall at the site of origin of the inferior turbinate. Conchoplasty was done and patient follow-up for 9 years is excellent with complete disappearance of all patient symptoms. Conclusions Concha bullosa of the inferior turbinate should be considered in the differential diagnosis of nasal tumors, nasal cystic lesions, and preoperative evaluation of endoscopic sinus surgery. Also, a systematic approach for dealing with nasal lesions with thorough examination and radiological review will be of great value in decision-making. The anatomy of the paranasal should be thoroughly examined prior to endoscopic sinus surgery to develop treatment strategies and to prevent possible complications.

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

<p class="abstract"><strong>Background:</strong> The aim of the study was to determine the prevalence of middle turbinate pneumatization in patients of Southern region of Saudi Arabia.<strong> </strong> </p><p class="abstract"><strong>Methods:</strong> 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. </p><p class="abstract"><strong>Results:</strong> 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.</p><p class="abstract"><strong>Conclusions:</strong> 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.</p>