The incidence of concha bullosa, unusual anatomic variation and its relationship to nasal septal deviation: A retrospective radiologic study

Morphological variations of the middle and superior turbinates, olfactory fossa and nasal septum in different sphenoid sinus pneumatization patterns

PURPOSE

Detailed assessment of the extrasinusal pneumatization of the superior and middle turbinate (SCB, MCB), olfactory fossa (OFP), and nasal septum (NSP) in coronal and sagittal sphenoid sinus (SS) pneumatization types provides a precise understanding of the surgical corridors used for skull base surgery. We aimed to analyze the relationships among these variations using computed tomography (CT) images.

METHODS

CT images of 153 patients were retrospectively analyzed for all types of sinonasal pneumatizations and volumes of SCB and sphenoid sinus, together with the prevalence of mucosal thickening of the sphenoid sinus (MTSS).

RESULTS

The prevalences of cellular, extensive, and complete SCB were 28.6%, 21.1%, and 23.5% in prepterygoid; 38.1%, 42.1%, and 35.3% in prerotundum; and 33.3%, 36.8%, and 41.2% in postrotundum CSSP types, respectively. The frequencies of lamellar, bulbous, and extensive MCB were 29%, 14.3%, and 33.3% in pterygoid, 38.7%, 57.1%, and 25.9% in prerotundum, 32.3%, 8%, and 40.8% in postrotundum CSSP types, respectively. SCB and MCB were observed unilaterally at 24.8% and 30% and bilaterally at 12.8% and 32.7%, respectively. OFP, NSP, and MTSS were detected at 24.2%, 31.4%, and 27.5%, respectively. Increased age was significantly associated with a lower probability of pneumatization in SS and MCB.

CONCLUSIONS

The data obtained showed that the degree of SS pneumatization significantly affected the frequencies of the SCB, MCB, OFP, NSP, and MTSS. Also, the SCB volume is significantly related to the CSSP types. Preoperative CT evaluation is crucial for surgeons to be aware of these variations and to avoid iatrogenic injury.

The Role of Diagnostic Nasal Endoscopy and Computed Tomography Scan in Chronic Rhinosinusitis in Adults: A Study of Clinical Correlation

Chronic rhinosinusitis (CRS) is an inflammatory disease affecting the paranasal sinuses (PNS) with a lifetime prevalence of approximately 15%, impacting about 1 in 8 Indians. The condition is rapidly evolving, with an exponential increase in cases due to rising atmospheric pollution and exposure to various allergens. CRS is one of the most common reasons for ENT consultations, significantly impairing patients' quality of life. Defined by inflammation lasting more than 12 weeks, CRS diagnosis relies on EPOS criteria using endoscopy and computed tomography (CT) scans. CRS affects about 11% of the global population and ranks among the top 10 costliest health conditions, highlighting the need for cost-effective and accessible diagnostic tools. This observational study was conducted in a tertiary care hospital and included 53 CRS patients (age 18-70 years) undergoing diagnostic nasal endoscopy (DNE) and non-contrast CT. The Lund-Mackay and Lund-Kennedy scores evaluated CT and DNE findings, respectively. Statistical analysis included descriptive, Mann-Whitney, chi-square tests, and Spearman correlation. Nasal obstruction (98.11%) predominated, with CT revealing maxillary sinus involvement (52.83%) and common anatomical variations such as a deviated nasal septum. DNE identified edema (66.03%) and nasal polyps (15.1%). A strong correlation (0.866) between Lund-Kennedy and Lund-Mackay scores validated DNE. DNE showed 91.31% sensitivity, 71.46% specificity, and 86.44% diagnostic accuracy versus CT. DNE proves to be reliable in CRS assessment, aligning well with CT findings. It offers a cost-effective initial evaluation and management option, crucial in resource-limited settings.

Investigation of nasal cavity alterations in individuals with neurofibromatosis type 1 using CBCT

OBJECTIVES

This study aimed to investigate nasal septum deviation (NSD), nasal bone length (NBL), and the morphology of the middle nasal conchae (MNC) and inferior nasal conchae (INC), as well as their correlations.

MATERIALS AND METHODS

The sample included 56 cone-beam computed tomography scans divided into two groups: a study group (SG; individuals with NF1; n = 28) and a control group (CG; individuals without NF1; n = 28). NSD, NBL, MNC, and INC classifications were assessed. MNC images were classified as normal, bullous, paradoxical, secondary, and accessory. INC images were classified as normal, lamellar, compact, combined, and bullous. Intra- and interobserver reliability were evaluated.

RESULTS

SG had a mean NSD of 11.6° (±4.5°) compared with 9.6° (±3.2°) for the CG, showing moderate deviations with no significant difference between groups. SG had a mean NBL of 22.4 mm (±3.4 mm) compared with 22.1 mm (±3.2 mm) for the CG, with a statistically significant difference. Both groups exhibited normal, bullosa, and accessory MNC classifications. SG INC were normal, lamellar, and combined, whereas CG INC were normal and lamellar. There was a weak correlation between NSD and NBL across groups.

CONCLUSION

Individuals with NF1 showed longer NBL. The weak correlation between NSD and NBL suggested multifactorial influences on these variations. These findings advance our understanding of craniofacial development in NF1 and highlight the need for further research into nasal cavity involvement in this complex genetic disorder.

Prevalence of concha bullosa in a pediatric population

OBJECTIVE

Existing literature on the prevalence of middle turbinate pneumatization, or concha bullosa (CB), in the pediatric population is limited. CB is an anatomic variant important to identify prior to sinonasal surgery and is often associated with congenital nasal septal deviation (SD). This paper aims to describe the prevalence of CB in the pediatric population on head imaging.

METHODS

A retrospective chart review was performed for 695 children undergoing CT head for trauma from 2021 to 2022. Nearly equal numbers of males and females were evaluated, with at least 19-20 per year from 0.5 to 18 years. Patients with significant facial fractures, sinusitis, craniofacial syndromes, prior sinus surgery, and sinonasal masses were excluded. Two pediatric neuroradiologists evaluated the CTs. CB was defined as aeration >50 % of the vertical height of the middle turbinate.

RESULTS

In this study, 384 patients were included. The prevalence of CB was 153 (39.8 %), which was significantly higher in children >4 years (p < 0.0001). Lamellar type CB was the most common, present in 160 out of 768 middle turbinates assessed (20.8 %). SD occurred in 60 (39.2 %) patients with CB and was more commonly contralateral to the CB.

CONCLUSIONS

The prevalence of CB in the pediatric population is at the lower range of what is reported in the adult literature. The most common type of CB in patients is lamellar. Similar to previous studies, there is an association between CB and contralateral SD. Finally, there is a positive correlation between the severity of CB and the severity of SD.

Unravelling the Complex Relationship Between Frontal Sinus Pneumatization and Paranasal Sinus Anatomical Variants: Insights from CT Imaging

The aim of this study was to analyse the relationship between frontal sinus pneumatization and its effect on various variations of paranasal sinuses on paranasal sinus CT scan. A total number of 100 patients (51 males, 49 females) were included in this study. Patients were divided into three groups on the basis of their frontal sinus pneumatization extent on paranasal sinus CT as Type 1 pneumatization (aplasia and hypoplasia), Type 2 pneumatization (medium) and Type 3 pneumatization (hyperplasia). The prevalence of various variations like pneumatization of upper and middle turbinate, presence of agger nasi, Haller and Onodi cell, maxillary sinus hypoplasia, extent of sphenoid sinus pneumatization, pneumatization of anterior clinoid process, pterygoid process and greater wing of sphenoid sinus, dehiscence and protrusion of internal carotid artery and optic nerve types were ascertained and compared within each group. The prevalence of Onodi cell, anterior clinoid process and greater wing of sphenoid pneumatization and optic nerves type 3 and 4 were higher in Type 3 frontal sinus pneumatization group as compared with other groups. Excessive pneumatization of frontal sinus has various effects on paranasal sinus variations. Surgeons dealing with endoscopic sinus surgery, maxillofacial and skull base surgery must be vigilant of association between these variations preoperatively for avoiding complications.

The incidence of concha bullosa: a retrospective radiologic study

AIM

This study was conducted to discuss the incidence, directions, and types of concha bullosa using studies in the literature.

MATERIALS AND METHODS

The images of patients who presented to the ENT clinic with different ENT symptoms in the last 7 years and had paranasal sinus tomography were analyzed retrospectively.

RESULTS

The study consisted of a total of 3133 patients, including 1534 females (48.96%) and 1599 males (51.03%). The age range of the cases was between 12 and 85 years, and the mean age was 57.25 years. Middle concha bullosa was detected in 1402 (44.74%) of the cases. Of these cases, it was determined that 320 (22.82%) had right, 311 (22.18%) had left, and 771 (54.99%) had bilateral middle concha bullosa. Of middle types of concha bullosa, lamellar type concha bullosa was detected in 575 (41.01%) patients, bulbous type in 363 (25.89%), and extensive type in 464 (33.09%). Of the cases with lamellar type middle concha bullosa, it was found that 130 (22.60%) had right side, 105 (18.26%) had left side, and 340 (59.13%) had bilateral lamellar type middle concha bullosa. Of the cases that were determined to have bulbous type middle concha bullosa, 97 (26.72%) had right side, 99 (27.27%) had left side, and 167 (46.00%) had bilateral bulbous type middle concha bullosa. Of the cases that were determined to have extensive type middle concha bullosa, 93 (20.04%) had right side, 107 (23.06%) had left side, and 264 (56.89%) had bilateral extensive type middle concha bullosa. The incidence of superior concha bullosa was determined in 487 (15.54%) of 3133 cases. Of these, bilateral superior concha bullosa was detected in 332 (68.17%) cases and unilateral in 155 (31.82%) cases.

CONCLUSIONS

Our study has the largest case series among studies investigating the incidence of concha bullosa. The incidence of concha bullosa appears to be common in the community. Additional studies may be useful to determine whether its high incidence is associated with other sinus pathologies and the extent of its effect on other rhinological complaints.

Effect of Functional Septorhinoplasty with Concha Bullosa Resection on Sinonasal Symptoms

OBJECTIVE

To evaluate the impact of functional septorhinoplasty (SRP) with and without concha bullosa resection (CBR) on sinonasal symptoms and nasal obstruction severity using the Nasal Obstruction Symptom Evaluation (NOSE) and Sino-Nasal Outcome Test-22 (SNOT-22) scale.

METHODS

Consecutive adult participants who underwent SRP were retrospectively analyzed. Patients were divided into two groups: Group 1 (SRPwCB) underwent SRP with CBR (bulbous or extensive type MTs), and Group 2 (SRPO) underwent SRP only (normal or lamellar-type MTs). The NOSE and SNOT-22 scales were assessed preoperatively and at the 3-month follow-up evaluation. Patient demographics, self-reported outcomes, nasoseptal angle (NSA), and Lund-Mackay scores (LMS) were analyzed.

RESULTS

There were 119 participants (SRPwCB n = 57; SPRO n = 62). There were no statistically significant differences in age, sex, allergy, smoking, LMS, and NSA according to the presence of MTCB. Compared to SRPO, SRPwCB patients had significantly higher preoperative NOSE and SNOT-22 scores, whereas their postoperative NOSE and SNOT-22 scores were similar. SRPwCB patients also had significantly more postnasal discharge, ear fullness, facial pain/pressure, poor sleep, night waking, daytime fatigue, sense of taste/smell, and blockage symptoms before surgery compared with SRPO patients.

CONCLUSION

SRPwCB patients had higher nasal obstruction and sinonasal symptom scores and greater improvement after surgery than SRPO patients. Therefore, evaluating the middle turbinate before functional SRP may be an important for surgical treatment of sinonasal symptoms.

LEVEL OF EVIDENCE

3 Laryngoscope, 2022.

Comparison of the Type and Severity of Nasal Septal Deviation between Chronic Rhinosinusitis Patients Undergoing Functional Endoscopic Sinus Surgery and Controls

Objectives

Some correlations have been proposed between chronic rhinosinusitis (CRS) and type and severity of nasal septal deviation. This study sought to compare the type and severity of nasal septal deviation between CRS patients undergoing functional endoscopic sinus surgery (FESS) and asymptomatic controls using cone-beam computed tomography (CBCT).

Materials and Methods

This prospective case-control study evaluated 49 CRS patients who did not respond to pharmaceutical therapy and were candidates for FESS and 49 asymptomatic controls. All participants underwent CBCT and were inspected for septal deviation type and severity. Data were analyzed by the independent t-test and chi-square test.

Results

The study population comprised of 58.25% males and 41.8% females, with a mean age of 33.74 ± 11.78 years. Significant correlations were noted between the presence of CRS and severity of septal deviation (P=0.007). Type of septal deviation had no significant correlation with the presence of CRS (P=0.443).

Conclusion

Patients with CRS have significantly more severe nasal septal deviation. However, type of septal deviation is not correlated with CRS.

Spur-of-the-Moment: An Exacting Nasal Intubation

Nasotracheal intubations are an important airway management technique in otolaryngologic surgeries and trauma distorting oropharyngeal structures. For those performing these procedures, nasal deformities are not uncommon. This case report highlights an example of recurrent cuff tears that occurred during nasotracheal intubation of a patient with an unknown nasal bone spur. A careful airway analysis with available imaging studies may predict the potential difficulty with nasotracheal intubation. A successful approach to nasotracheal intubation can then be attempted on the contralateral side if a nasal bone spur is present.

The Relationship Between Degree of Nasal Septum Deviation With Sinonasal Structures and Variations

ABSTRACT

We aimed to evaluate whether the nasal septum deviation affects the development of sinonasal structures. Patients who had undergone paranasal sinus computed tomography (PNS-CT) imaging due to nasal obstruction were divided into 3 groups according to the septal deviation angle; group I: 0° to 9°, group II: 10° to 15°, and group III: >15°. The features of sinonasal structures were recorded when evaluating PNS-CT. There were totally 234 patients, 119 patients in group I, 68 in group II, and 47 in group III. On the opposite side of the deviation, keros 3 was significantly more in group III (P < 0.001). Although the incidence of concha bullosa and agger nasi cell were not affected by the degree of deviation (P > 0.05), the incidence of Haller and Onodi cells were significantly higher in group III (P < 0.001). In addition, all cells were observed more in the opposite side of the deviation in each group (P < 0.001). Maxillary sinus retention cysts and hypoplasia of maxillary and frontal sinuses, as an indicator of the low pneumatization of the sinuses, are seen more on the same side of nasal septum deviation, increasing with the degree of deviation increases (P < 0.001). Nasal septum deviation affects the development of sinonasal structures by affecting the pneumatization. Preoperative PNS-CT evaluation is important in order to be aware of the situations that we may encounter during surgery and to provide adequate treatment.

Septoplasty alone is not suitable for most structural nasal obstructions

Septoplasty is widely used in the treatment of structural nasal obstructions, and it also has a good effect and a high degree of postoperative satisfaction. However, there a large number of structures demonstrate abnormalities related to structural nasal obstruction, including the external nose, maxilla, nasal cavity and paranasal sinus. Nasal septum deviation is only one signs of structural nasal obstruction and does not represent all possible structural abnormalities of the nasal cavity and its surrounding structure. Septoplasty is only performed to correct deviations of the nasal septum, which in many cases is obviously insufficient in restoring the symmetry of the nasal structure. Therefore, septoplasty alone is not suitable for the treatment of most structural nasal obstructions. Nasal ventilation expansion surgery, which typically covers more abnormal structural correction procedures than septoplasty, should be used when describing the treatment of structural nasal obstruction.

Concha Bullosa of the Inferior Turbinate

Inferior concha bullosa is a rare disease that has been related to sinonasal symptoms. This study aimed to determine the characteristics of concha bullosa in the inferior turbinate and assess its common clinical manifestations, computed tomography findings, and the surgical techniques used to treat the condition. We conducted a search of the PubMed database, using the Preferred Reporting Items of Systematic Reviews and Meta-Analysis, for articles published until May 2021 using the following terms: "inferior turbinate and concha bullosa"; "inferior turbinate and pneumatization"; and in combination with other terms such as "concha bullosa release and concha bullosa excision", among others. We found 12 papers that met our inclusion criteria. The main presenting symptom was a nasal obstruction in 13 patients (100%), followed by headache in 10 patients (77%). The site of inferior concha bullosa was bilateral in six cases and left-sided in five cases. Computed tomography was conducted in all cases in this review. The type of intervention performed was medical, surgical, and both in 23%, 54%, and 23% of the cases. Despite multimodal surgical approaches and medical treatment, all the outcomes were good and no compactions were noted. All cases also had good prognoses.

Asymmetry of inferior turbinate in patients with nasal septum deviation and its significance for nasal ventilation surgery

PURPOSE

To investigate the asymmetry of the inferior turbinate (IT) in patients with nasal septum deviation (NSD).

METHODS

The paranasal sinus computed tomography (CT) of 100 patients with NSD were retrospectively investigated from February 2018 to December 2019. The thickness of IT, IT mucosa and IT bone, the distance between the IT and the midline were measured on both the concave and convex sides, and which correlation with NSD was analyzed.

RESULTS

The widths of the IT, IT bone and IT medial mucosa on the concave side were larger than those on the convex side (all P < 0.05). The distance from the IT and IT bone to the midline on the concave side was smaller than those on the convex side (P < 0.05, respectively). The degree of NSD had a negative correlation with the widths of the IT and IT bone on the convex side, and the distance between the IT and the midline on the concave side; and a positive correlation with the distance from IT and IT bone to the midline on the convex side, and IT mucosa thickness on the concave side (all P < 0.05).

CONCLUSION

The asymmetric IT width is mainly caused by both hypertrophies of the IT mucosa on the concave side and atrophy of the IT bone on the convex side. Therefore, during the surgery of nasal ventilation reconstruction, the IT on the convex side are suggested to be protected from intervention. In contrast, it is necessary to lateralize the IT bone and reduce the IT submucosal tissue on the concave side. However, routine excision of the IT bone is not recommended.

Concha Bullosa of the Inferior Turbinate: Report of Two Cases

Concha bullosa (CB) is defined as pneumatization and the presence of air cells within the nasal turbinates. Inferior concha bullosa (ICB) is a rare anatomical variation of the lateral nasal wall, with only a handful of case reports published in the literature to date. In this article, we present two additional cases of ICB and a review of the literature regarding this rare anatomical variation.

Rhinolith in the concha bullosa as a rare location: a case report

The presence of a rhinolith is a rare condition, which can cause long-standing symptoms, such as rhinorrhea, foul-smelling discharge, nasal obstruction, and headache. A rhinolith is usually easily diagnosed by a clinical examination and a paranasal computed tomographic scan. Rhinoliths are usually found in nasal cavities, but rare locations are also possible. We report a patient who was evaluated in our clinic for nasal obstruction, headache, and snoring symptoms. A clinical examination showed no major findings, but a paranasal computed tomographic scan of coronal sections showed a hyperdense mass within the right concha bullosa. A rhinolith in the concha bullosa is a rare condition. Our case is the third case of a rhinolith in the concha bullosa to be reported in the literature.

Nasal Septal Swell Body: A Distinctive Structure in the Nasal Cavity

OBJECTIVES

The nasal septal swell body (NSB), also known as the nasal septal turbinate, is located in the anterior part of the nasal septum. This study is a narrative review of the existing knowledge on recent developments in NSB.

METHODS

A literature search was performed using PubMed, Embase, Web of Science, Ovid, and Cochrane Library databases. Google Scholar was used to access more extensive literature. The inclusion criteria were human studies published in English. The exclusion criteria were non-English language and animal studies.

RESULTS

Of the 345 articles that were initially obtained from 5 databases and Google Scholar, 28 were included in this review. There have been many names for NSBs in the past, which still have no unified terminology recognized by professionals. Pathological investigations revealed that NSB contains a certain amount of sinusoidal blood components. Nasal septal swell body is closely related to the internal nasal valve. Imaging studies have found that the size of NSB is associated with nasal diseases, and NSB hypertrophy can cause anatomic obstruction. In recent years, several procedures for NSB have been reported, and preliminary effectiveness has been achieved. However, the long-term outcomes of volume reduction techniques remain unproven.

CONCLUSIONS

The NSB is a distinct anatomic structure that may contribute to nasal obstruction and may be reduced surgically with unclear long-term results. Although being investigated for over a century, the unique physiological roles of NSB are not yet fully understood. More evidence is needed to elucidate its physiological effects.

Factors influencing the sinus membrane thickness in edentulous regions: a cone-beam computed tomography study

BACKGROUND

During implant treatment in the maxillary molar area, maxillary sinus floor augmentation is often performed to ameliorate the reduced alveolar bone height attributable to bone remodeling and pneumatization-induced expansion of the maxillary sinus. However, this augmentation may cause complications such as misplaced implants, artery damage, and maxillary sinus mucosal perforation; infections like maxillary sinusitis; and postsurgical complications such as bone graft leakage and postoperative nasal hemorrhaging. To reduce the complications during maxillary sinus floor augmentation and postoperative infections, we performed retrospective investigations of various systemic and local factors that influence pre-operative sinus mucosal thickness (SMT) by using cone-beam computed tomography (CBCT). Subjects included patients who underwent maxillary sinus floor augmentation in an edentulous maxillary molar area with a lateral approach. Pre-operative SMT, existing bone mass, and nasal septum deviation were measured using CBCT images. Relationships between SMT and the following influencing factors were investigated: (1) age, (2) sex, (3) systemic disease, (4) smoking, (5) period after tooth extraction, (6) reason for tooth extraction, (7) residual alveolar bone height (RBH), (8) sinus septa, and (9) nasal septum deviation. Correlations were also investigated for age and RBH (p < 0.05).

RESULTS

We assessed 35 patients (40 sinuses; 11 male, 24 female). The average patient age was 58.90 ± 9.0 years (males, 57.9 ± 7.7 years; females, 59.9 ± 9.4 years; age range, 41-79 years). The average SMT was 1.09 ± 1.30 mm, incidence of SMT > 2 mm was 25.0%, incidence of SMT < 0.8 mm was 50.0%, and the average RBH was 2.14 ± 1.02 mm. The factors that influenced SMT included sex (p = 0.0078), period after tooth extraction (p = 0.0075), reason for tooth extraction (p = 0.020), sinus septa (p = 0.0076), and nasal septum deviation (p = 0.038).

CONCLUSIONS

Factors associated with higher SMT included male sex, interval following tooth extraction < 6 months, periapical lesions, sinus septa, and nasal septum deviation. Factors associated with SMT > 2 mm were sex and reason for tooth extraction, while factors associated with SMT < 0.8 mm were time following tooth extraction and nasal septum deviation. Despite the limitations of this study, these preoperative evaluations may be of utmost importance for safely conducting maxillary sinus floor augmentation.

[The effect of various types of nasal septal deviation, concha bullosa and hypertrophic inferior turbinate on the development of sinusitis]

OBJECTIVE

To determine the impact of various types of unilateral nasal septum deviation (NSD), concha bullosa (CB) and hypertrophic inferior turbinate (HIT) on the development of sinusitis.

MATERIAL AND METHODS

This study was conducted in the Irkutsk State Medical University and the Irkutsk City Clinical Hospital No. 1 from October 2017 to November 2018. By continuous sampling retrospective analysis of 1300 protocols of paranasal sinuses MSCT of adult patients was performed. We used MSCT scanners Somatom Emotion 16 Siemens and GE BrightSpeed 16. The studies were carried out on the patients lying on the back with the subsequent reconstruction on a graphical station in the coronal and axial projections using the slices around 1 mm in the thickness. Inclusion criteria: unilateral or absence NSD. Exclusion criteria: bilateral NSD, chronic polyposis or allergic rhinitis. We have analyzed 272 protocols: 70 without NSD and 172 with unilateral NSD, on the right side - 89 (52%) and on the left - 83 (48%). 108 (44.6%) patients were male and 134 (55.4%) were female with average age 38.5±12 years. All patients were divided into 4 groups by R. Mladina' classification (1987): with NSD types 1, 2, 3, and 5. The results were evaluated using the Yates corrected chi-square and the Fisher's exact test by Statistica 10.0.

RESULTS

There were 34 patients with NSD type 1: 12 with sinusitis; 9 had CB: 6 with sinusitis, 3 without it; HIT was in 27 cases: 33% with sinusitis, 67% without it. There were 69 patients with NSD type 2: 12 had sinusitis; 22 had CB: 5 with sinusitis, 17 without it; HIT was in 42 cases: 26% with sinusitis, 74% without it. There were 43 patients with NSD type 3: 26 had sinusitis; 15 had CB: 6 with sinusitis, 9 without it; 30 had HIT: 57% with sinusitis, 43% without it. There were 26 patients with NSD type 5: 11 had sinusitis; 9 had CB: 3 with sinusitis, 6 without it; 24 had HIT: 42% with sinusitis, 58% without it. NSD type 2 was statistically significant prevailed in patients without sinusitis (p=0.000005); NSD type 3 (p=0.03) and the combination of NSD type 1 with contralateral CB (p=0.04) prevailed in patients with sinusitis.

CONCLUSION

NSD type 3 (by R. Mladina), as well as the combination of type 1 with contralateral CB are have influence to the development of sinusitis. CB and HIT are statistically significant prevailed on the contralateral side to unilateral NSD, but do not affect to development of sinusitis.

Nasal cavities and the nasal septum: Anatomical variants and assessment of features with computed tomography

The nasal cavities are complex anatomical structures with high inter-individual variability that relates to different functions. Different anatomic variants may manifest at this site, mainly belonging to the nasal septum and turbinates. Precise knowledge of the anatomy and variants is fundamental for both radiologists and ENT surgeons. This article provides an overview of the main anatomic variants and their frequency, according to the existing literature, as well as ongoing research on nasal cavity segmentation in order to obtain personal 3D models and to predict post-surgical results.

Does Nasal Septal Deviation and Concha Bullosa Have Effect on Maxillary Sinus Volume and Maxillary Sinusitis?: A Retrospective Study

Purpose

This study aimed to determine whether nasal septal deviation and concha bullosa affect the maxillary sinus volume, and whether this effect is associated with the prevalence of chronic sinusitis.

Materials and Methods

This study retrospectively reviewed 209 paranasal sinus CT (PNS CT) images of patients with sinonasal symptoms from January 2017 to December 2018. The maxillary sinus volume was measured twice by a radiologist, and statistical analysis was performed using SAS 9.4.

Results

Intersex comparison of the maxillary sinus volume (on left and right sides) revealed that the volume was significantly larger on both the sides (p < 0.0001) in men compared with that in women. Concha bullosa was found to occur mainly in the concave cavity of the septal deviation (p < 0.0001). No significant association was found between nasal septal deviation and maxillary sinusitis (p = 0.8756) as well as between concha bullosa and maxillary sinusitis prevalence (p = 0.3401) or maxillary sinus volume (both: p = 0.6289, Rt.: p = 0.9522, Lt.: p = 0.9201).

Conclusion

Although nasal septal deviation and the location of concha bullosa may affect each other, maxillary sinus volume and maxillary sinusitis were neither associated with nasal septal deviation nor concha bullosa.

Concha bullosa. A radiological study and a new classification

OBJECTIVE

A pneumatised middle turbinate is called concha bullosa. It has been classified according to its extension in the coronal plane. We propose the first classification according to the axial extension of pneumatisation of the middle turbinate.

MATERIAL AND METHODS

Bulbous concha bullosa was classified in six categories according to the degree of pneumatisation of the body of the middle turbinate in the axial plane.

RESULTS

196 CT sinonasal scans were included. 28.06% of patients had concha bullosa, unilateral in 13.26% and bilateral in 14.79%. The most common concha bullosa found was type I, followed by type III, II, IV and V. There were no statistically significant differences by side, between the patients with or without chronic rhinosinusitis without polyps.

CONCLUSION

Our results support the hypothesis that concha bullosa is not related to chronic rhinosinusitis. Furthermore, type IV and V cells mean posterior aeration of the middle turbinate. Those variations are rare and posterior, so they can easily pass unnoticed during endoscopic sinus surgery. Our classification is also important as a surgical reference, and it can be easily studied on the preoperative CT scan.

Anatomical Variations of the Nose and Paranasal Sinuses: A Computed Tomographic Study

To evaluate the anatomical variations in computed tomographic (CT) images of paranasal sinuses and to investigate association between them.

DESIGN

Retrospective study.

SETTING

Tertiary care center in the southern part of India.

SUBJECTS

Radiological images of paranasal sinuses belonging to chronic rhinosinusitis patients managed between June 2016 and November 2018.

METHODS

The studied characteristics in the CT images included the deviated nasal septum (DNS), concha bullosa (CB), Haller cell (HC), Onodi cell (OC), pneumatization of anterior clinoid process (ACP), pterygoid base (PB), superior turbinate, inferior turbinate, crista galli (CG), and nasal septum. The height of the lateral lamella of the cribriform plate, the sphenoid pneumatization pattern, and the optic nerve relationship with sphenoid sinus were studied separately. The associations between these factors, and with maxillary sinus opacifications were also investigated. A total of 151 adult patients' CT images were analyzed. The most common manifestations noted were DNS, CB and pneumatized PB, seen in 83.4%, 49% and 47% of the patients respectively. The rates of HC, OC, pneumatized septum, pneumatized CG, and pneumatized ACP were 39%, 23%, 27%, 43% and 27% in that order. Rates of most of these variations were within the range reported in the literature. Chi square test revealed that the OC was independently associated with pneumatized CG and pneumatized septum. The maxillary sinus opacification was related to DNS and CB, but not with protrusion of tooth root into the sinus. Most of the anatomical variations were comparable with the reports across the globe, however, the associations between these variations weren't common in our cohort.

The Analysis of Computed Tomography of Paranasal Sinuses in Nasal Septal Deviation

OBJECTIVES

Anatomic variations of paranasal sinuses are frequent among population that should be analyzed and interpreted accurately. The purpose of this study is to analyze anatomical variants and their relationships of paranasal sinuses in patients with nasal septal deviation undergoing septoplasty.

METHODS

A total number of 150 patients (74 males, 76 females) with nasal septal deviation undergoing septal surgery were included in this retrospective study. The authors analyzed the direction and the angle of the nasal septal deviation, variations of the nasal turbinates, ethmoidal air cells, paranasal sinus pneumatization, accessory pneumatization of the paranasal complex and sphenoid sinus-related structures and the Keros, optic nerve and Vidian canal classification, and relationships between these structures in the paranasal computed tomography of the patients.

RESULTS

The incidence of concha bullosa, Onodi cell, and anterior clinoid pneumatization were higher in patients with nasal septal deviation when compared with current literature.

CONCLUSION

Physicians and surgeons dealing with the nose and maxillofacial region should be able to analyze paranasal computed tomography by themselves and must be aware of these variations during performing septal and craniomaxillofacial surgery.

Correlations between anatomical variations of the nasal cavity and ethmoidal sinuses on cone-beam computed tomography scans

Purpose

Anatomical variations of the external nasal wall are highly important, since they play a role in obstruction or drainage of the ostiomeatal complex and ventilation and can consequently elevate the risk of pathological sinus conditions. This study aimed to assess anatomical variations of the nasal cavity and ethmoidal sinuses and their correlations on cone-beam computed tomography (CBCT) scans.

Materials and Methods

This cross-sectional study evaluated CBCT scans of 250 patients, including 107 males and 143 females, to determine the prevalence of anatomical variations of the nasal cavity and ethmoidal sinuses. All images were taken using a New Tom 3G scanner. Data were analyzed using the chi-square test, Kruskal-Wallis test, and the Mann-Whitney test.

Results

The most common anatomical variations were found to be nasal septal deviation (90.4%), agger nasi air cell (53.6%), superior orbital cell (47.6%), pneumatized nasal septum (40%), and Onodi air cell (37.2%). Correlations were found between nasal septal deviation and the presence of a pneumatized nasal septum, nasal spur, and Haller cell. No significant associations were noted between the age or sex of patients and the presence of anatomical variations (P>0.05).

Conclusion

Radiologists and surgeons must pay close attention to the anatomical variations of the sinonasal region in the preoperative assessment to prevent perioperative complications.

What are the risk factors for maxillary sinus pathologies? A CBCT study

OBJECTIVE

Some anatomic variations may interfere with proper airflow in the maxillary sinus and predispose to maxillary sinus pathologies. It was also reported that as a result of the transport of microorganisms from infected periapical tissues, maxillary sinus pathologies can develop. The objective of this study was to determine the potential relationships of maxillary sinus septa, concha bullosa, nasal septal deviation, and teeth with periapical lesion to maxillary sinus pathologies.

METHODS

200 cone beam computed tomography scans obtained at Necmettin Erbakan University, Faculty of Dentistry from 2013 to 2018 were retrospectively reviewed for the presence of maxillary sinus septa, concha bullosa, nasal septal deviation, teeth with periapical lesions, and maxillary sinus pathologies. When maxillary sinus mucosal thickening exceeded 2 mm, it was considered as a pathological condition. Logistic regression analysis was used to determine the risk factors for maxillary sinus pathologies. p < 0.05 considered statistically significant.

RESULTS

185 (46.2%) of the 400 maxillary sinuses showed maxillary sinus pathologies. Maxillary sinus septa, concha bullosa, and nasal septal deviation were not found to be as a risk factor for the maxillary sinus pathologies (p > 0.05). At least one apical lesion adjacent to the maxillary sinus increased the maxillary sinus pathology by 5.24 times on the right (OR 5.24, p < 0.001) and by 4.67 times on the left side (OR 4.67, p < 0.001).

CONCLUSION

To prevent maxillary sinus pathologies, it is important for the teeth adjacent to the maxillary sinus to be healthy.

The effect of frontal sinus pneumatization on anatomic variants of paranasal sinuses

PURPOSE

The aim of this study is to determine the effect of frontal sinus pneumatization on various variations of paranasal sinuses on maxillofacial CT.

MATERIALS AND METHODS

A total number of 120 patients (62 females, 58 males) were included in this study. Patients were divided into three groups regarding their frontal sinus pneumatization extent on paranasal sinus CT as Type 1 pneumatization (aplasia and hypoplasia), Type 2 pneumatization (medium) and Type 3 pneumatization (hyperplasia). The prevalence of various variations on paranasal sinus CT like pneumatization of upper and middle concha, presence of agger nasi, Haller and Onodi cell, maxillary sinus and sphenoid sinus hypoplasia, pneumatization of anterior clinoid process, pterygoid process and greater wing of sphenoid sinus, dehiscence and protrusion of internal carotid artery and optic nerve and vidian canal types were ascertained and compared within each group.

RESULTS

The prevalence of upper and middle concha pneumatization, Haller cell, pneumatization of anterior clinoid process, pterygoid process and greater wing of sphenoid and internal carotid artery dehiscence and protrusion was higher in Type 3 group compared with other groups.

CONCLUSION

Excessive pneumatization of frontal sinus has various effects on paranasal sinus variations at maxillofacial CT. Surgeons dealing with endoscopic sinus surgery, maxillofacial and skull base surgery must be vigilant of association between certain variations when analyzing CT scan preoperatively for avoiding complications.

Incidental Findings in TMJ Imaging

For years, the conventional imaging modalities are generally used in dental practice routine. They provide precious information about dentomaxillofacial region; they also have some limitations such as superimpositions, magnifications, distortions, and low-image quality. Because of these limitations, some pathologies, calcifications, and anatomical variations may be missed. Any findings on a radiographic image which are not related to the research areas of interest could be a description of “incidental findings.” Calcifications are one of these incidental findings. They are asymptomatic and also common in TMJ images. Although most of the calcifications require no treatment, correct identification will reduce further diagnostic assessments. Incidental findings on TMJ images were rare, while examining images for temporomandibular disorders and associated issues, it is important not only to examine the TMJ structures but also to look at the nearby anatomical features to check for evidence of incidental findings pathologies that may have mimicked signs and symptoms of TMJ disorders.

Anatomical Variations of the Middle Turbinate Concha Bullosa and its Relationship with Chronic Sinusitis: A Prospective Radiologic Study

Introduction  A pneumatized turbinate, also called concha bullosa, is a normal anatomical variant of the paranasal sinus region. Depending on the site of pneumatization, the concha is classified into extensive, bulbous or lamellar type. The middle turbinate concha bullosa has been implicated as a possible etiological factor in chronic sinusitis. Objectives  The aim of this study was to investigate the anatomical variations of the concha bullosa, based on paranasal sinus imaging, and its possible association with sinusitis. Methods  This prospective descriptive study was performed at the Department of ENT and Head Neck Surgery over a period of one year, from 2016 to 2017. We studied the computed tomography scans of the nose and paranasal sinuses- in axial, coronal and sagittal planes-of patients who had symptoms of nasal obstruction, or headache and features of chronic sinusitis. Results  Out of the 202 scans studied, the prevalence of concha bullosa was 31.7%. The concha was bilateral in 35 (54.7%) patients and unilateral in 29 (45.3%) patients. Out of 99 conchae, 54 were on the right side and 45 were on left side. Ipsilateral sinusitis was found in 40.4% of the sides in the scans of subjects with concha. There was no statistically significant association between any type of middle turbinate concha with sinusitis, but sinusitis was more predominant with the extensive type of concha ( p  > 0.05). Conclusion  Multiple air cells, mucocele, pyocele and inflammatory mucosal thickenings in the concha are relatively rare. Detailed knowledge of anatomic variations of the concha bullosa is imperative for the radiologists and the operating surgeons.

Evaluation of superior concha bullosa by computed tomography

OBJECTIVE

Concha bullosa is generally regarded as pneumatisation of the middle turbinate in the nose. However, pneumatisation may also be seen in the superior and inferior turbinate. Computed tomography (CT) of paranasal sinuses is extremely helpful for the examination of this inaccessible area. Coronal CT sections of paranasal sinuses are particularly useful for surgical anatomy, as these images show nearly the same regions as the endoscopic examinations. The aim of this retrospective study was to evaluate the presence, incidence and unilaterality-bilaterality of superior turbinate pneumatisation and concomitant nasal pathologies.

METHODS

A total of 1000 patients who underwent CT of the paranasal sinuses because of headaches, nasal obstructions, anosmia, facial pain or facial trauma were evaluated retrospectively.

RESULTS

Among the 1000 patients, superior pneumatized turbinate was seen on CT images of the paranasal sinuses in 149 (14.9%) cases. Of these patients, 84 were female, 65 were male, and the mean age was 38.14 years. Among 149 patients, 58 patients had bilateral superior pneumatized turbinate and the remaining 91 patients had unilateral superior pneumatized turbinate. 60.4% of the patients with superior pneumatized turbinate also had middle pneumatized turbinate.

CONCLUSION

The superior pneumatized turbinate is an anatomical variation with an incidence ranging from 12.2 to 50%. The present study revealed that there is no relationship between volume size of the superior pneumatized turbinates and sinusitis, nasal septum deviation and paradoxical middle concha. It is very important to define anatomical variations in the preoperative CT evaluation of the paranasal sinuses.