Massive concha bullosa masquerading as an intranasal tumor

Concha bullosa mucocele: A case series and review of the literature

Background:

Concha bullosa mucocele is a rare diagnosis that presents as a nasal mass. It impinges on surrounding structures and can easily be mistaken for a neoplasm.

Objective:

The objective of this study was to shed light on this rare entity and report its diagnostic features and treatment outcomes.

Methods:

A case series conducted in a tertiary health care center. Demographic data, clinical presentation, imaging, cultures, and treatments were recorded. Operative video illustration and key images were obtained. A review of the literature was also performed.

Results:

A total of five cases were reviewed, four of which were concha bullosa mucoceles and one was a mucopyocele. Three of the patients had some form of previous nasal trauma. Headache and nasal obstruction were the most common symptoms with a nasal mass finding on physical examination. Computed tomography was used in all the patients, and magnetic resonance imaging was used in four of the five patients. Four patients had coexistent chronic rhinosinusitis, and three had positive bacterial cultures. All these patients were treated endoscopically either with middle turbinate marsupialization or subtotal resection. No recurrence has been noted thus far.

Conclusion:

Concha bullosa mucocele is a rare diagnosis. Imaging characteristics are helpful in considering the diagnosis, although surgical intervention is often necessary to confirm the diagnosis and treat concha bullosa mucocele.

A concha bullosa mucopyocele manifesting as migraine headaches: a case report and literature review

A concha bullosa is a common anatomic variant that represents an aerated turbinate, usually the middle turbinate. It is usually asymptomatic. When extensively pneumatized, a large concha bullosa may cause significant problems, including headache, nasal obstruction, and blockage of sinus drainage. We report a case of a large concha bullosa mucopyocele that manifested as recurring migraine headaches. It was successfully treated with surgical excision. We also review the available literature.

Concha bullosa pyocele

An aerated middle turbinate is called a concha bullosa (CB), and given the importance of the middle turbinate in nasal physiology, variations that alter the airflow and mucous drainage can cause sinonasal symptoms. A pyocele of the middle turbinate differs from an infected CB because it has the potential to expand and destroy neighbouring tissues like a tumour. We present a concha bullosa pyocele (CBP) that expanded against the lamina papyracea without causing orbital displacement. As pus was discharged whilst performing an endoscopic biopsy to determine whether it was neoplastic, the lateral aspect of the turbinate was excised to complete the procedure.

Massive concha bullosa pyocele with orbital extention

Concha bullosa is the most common anatomic variant of the middle turbinate. It remains usually asymptomatic. Pyocele occurs when concha bullosa becomes infected. In the formation of a pyocele, middle turbinate may become expanded and occupy the surrounding structures with local bone destruction. Direct extension of mass from the nose into the orbit may occur, because the orbital contents are separated from the ethmoidal labyrinth only by the thin lamina papyracea. We report a case of concha bullosa pyocele with orbital extension. Orbital involvement is also associated with ocular functional loss. In this case, ocular motion and vision remained normal despite of the presence of orbital extension for 2 years.

Bilateral Massive Conchae Bullosa Mimicking Intranasal Tumors

We describe a case of bilateral massive conchae bullosa in a 76-year-old woman. She presented with a 2-year history of nasal obstruction and frontal headache. In light of these and other findings on anterior rhinoscopic and endoscopic examinations, we initially suspected nasal tumors. However, after a prebiopsy evaluation by computed tomography, we diagnosed bilateral massive conchae bullosa that did not impair sinus ventilation. Endoscopic surgery was performed, and the patient's symptoms abated.

[Malignant tumor's of nasal fossae: anatomoclinic's study and a new classification: study about 21 cases]

PURPOSE

This work proposes to study the anatomoclinical, therapeutic and evolutionary characteristics of the malignant tumours of the nasal cavities. This study focuses exclusively on the malignant tumours strictly of the endonasal variety (excluding tumours from the olfactive placode and those extending to the paranasal cavitie). These tumours are not common not often studied in the literature and their is not codified (classification, treatment). A new classification of the malignant tumours (strictly endonasals varieties) is presented in this study.

PATIENTS AND METHODS

This is a retrospective study of 21 malignant tumours of the nasal cavities selected between January 1989 and December 2001. The handling of these tumours rests on a tripod diagnosis: nasal endoscopy-imagery-biopsy. The following parameters are studied: epidemiological, histopathological, clinical, therapeutic and evolutionary.

RESULTS

The average age of our population is 52,4 years with a male sex ratio of 1,3. The nasal obstruction is the principal revealing sign (82%) followed by the epistaxis (14,2%). The septal tumours are the most frequent (10 cases). The histopathological results of our study show the prevalence of the epithelial tumours: epidermoid carcinoma (8/21), adenocarcinoma (2/21) malignant melanoma (2/21). The non-epithelial varieties are dominated by lymphomas (NLH) (8/21). The surgery plays a dominant role in the treatment of these tumours. Most of the tumours were operated on, usually transfacially and often with postoperative radiotherapy. The endoscopic surgery was not valided. Our results show on the one hand the gravity of certain tumoral varieties: malignant melanoma, lymphomas(NHL) and on the other hand the overall unfavourable forecast of these tumours with a mortality rate of 42,8%.

CONCLUSION

The malignant tumours of the nasal fossae, in particular in the specific context of this study (strict endonasal tumours) are rare and their handling is not codified. They are dominated by the epithelial malignant varieties, in particular in their septal localizations. The evolutionary profile is dominated by the loco regional recurrence. The forecast of these tumours is overall bad according to the tumoral stage, especially the histopathological varieties.

Subdural empyema complicating a concha bullosa pyocele

Concha bullosa is the most common anatomic variant of the middle turbinate and remains usually asymptomatic. We report a case of concha bullosa pyocele with a subdural empyema in a 11-year-old girl presenting with a subcutaneous tumefaction without neurologic deficit. Computed tomography and magnetic resonance imaging confirmed a subdural empyema communicating with subcutaneous effusion and the presence of a concha bullosa pyocele being responsible for the obstruction of ostiomeatal complex leading to frontal sinusitis. Resection of the middle turbinate with a middle meatotomy and a frontal skin incision combined with an adequate antibiotic treatment allowed this child to recover within 6 weeks.