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Al-Kholaiwi FM, Al-Khatabi RA, Al-Shehri GA, Al-Ghonaim YA. Giant concha bullosa presented as left nasal mass: a case report and literature review. J Surg Case Rep 2023; 2023:rjad558. [PMID: 37854521 PMCID: PMC10581697 DOI: 10.1093/jscr/rjad558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2023] [Accepted: 09/21/2023] [Indexed: 10/20/2023] Open
Abstract
Concha bullosa (CB) is not considered to be a disease, but rather a variation of the paranasal sinus. A CB is defined as the presence of an air cell within the turbinate (pneumatization). The main function of CB is to maintain upper respiratory humidity, regulate thermoregulation, and regulate airflow and filtration. It is common for CB to occur in the middle turbinate, while superior and inferior locations appear to be rare. The patient in this case report was presented mainly with nasal obstruction. During examination, a large mass was found in the left nasal cavity, causing a deviated nasal septum to the right. For this patient, surgery was the last resort. Either perioperative or postoperative complications were observed, and the quality of life of patients improved after surgery.
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Affiliation(s)
- Feras M Al-Kholaiwi
- Department of Otolaryngology - Head and Neck Surgery, Imam Mohammad Ibn Saud Islamic University (IMSIU) 11564, Riyadh, Saudi Arabia
| | - Reema A Al-Khatabi
- College of Medicine, Imam Mohammad Ibn Saud Islamic University (IMSIU) 11564, Riyadh, Saudi Arabia
| | - Ghada A Al-Shehri
- College of Medicine, Imam Mohammad Ibn Saud Islamic University (IMSIU) 11564, Riyadh, Saudi Arabia
| | - Yazeed A Al-Ghonaim
- Department of Otolaryngology - Head and Neck Surgery, King Saud Bin Abdulaziz University for Health Sciences (KSAU-HS) 11481, Riyadh, Saudi Arabia
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Marlapudi SK, Bishnoi T, Kumar S, Gurpreet WC. Middle Turbinate Pyocele, an Uncommon Differential for Nasal Mass: A Case report. Indian J Otolaryngol Head Neck Surg 2023; 75:2359-2362. [PMID: 37636595 PMCID: PMC10447755 DOI: 10.1007/s12070-023-03667-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2022] [Accepted: 03/03/2023] [Indexed: 08/29/2023] Open
Abstract
Mucoceles are respiratory epithelium-lined cystic lesions found in the paranasal sinuses. Pyocele occurs when a mucocele becomes infected. Mucoceles develop as a result of obstruction of the normal sinus drainage tract with superadded infection. Inflammatory mediators are secreted, which lead to bone resorption and expansion of the mucocele. Concha bullosa is one of the most common anatomical variations in the nasal cavity. It refers to an air-filled cavity within the middle turbinate. Obstruction of the concha bullosa can rarely lead to the formation of a mucocele which may be secondarily infected forming a mucopyocele. The mucocele of the middle turbinate may present as an uncommon cause of nasal obstruction, headache, and other nasal or ocular symptoms, which, if correctly diagnosed, can be completely reversed by endoscopic surgery.
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Affiliation(s)
| | - Tapasya Bishnoi
- Department of ENT-HNS, Command Hospital Airforce, Bangalore, India
| | - Sanjay Kumar
- Department of ENT-HNS, Command Hospital Airforce, Bangalore, India
| | - Wg Cdr Gurpreet
- Department of Pathology, Command Hospital Airforce, Bangalore, India
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Alsalamah S, Jarman Y, Alsanea M, Asiri M, Alhedaithy R. Bilateral enlarged concha bullosa: a case report and literature review. J Surg Case Rep 2023; 2023:rjad508. [PMID: 37724069 PMCID: PMC10505511 DOI: 10.1093/jscr/rjad508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 08/26/2023] [Indexed: 09/20/2023] Open
Abstract
Concha Bullosa (CB) is a common sinonasal anatomical variant, which commonly extends into the middle turbinate. Generally, patients presenting with CB are asymptomatic and often incidentally diagnosed with a non-contrast computed tomography scan of the paranasal sinuses. In cases of extensive pneumatization, large CB may cause significant signs and symptoms-commonly, headaches, nasal obstruction, and hyposmia. With only a few reported cases of large CB in the literature; we herein, report a rare case of an unusually massive bilateral CB that resulted in complete obstruction of the left nasal cavity and partial obstruction of the right nasal cavity, in addition to a review of relevant literature.
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Affiliation(s)
- Shmokh Alsalamah
- Department of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, P.O. Box 3660 Postal code 11481, Saudi Arabia
| | - Yazeed Jarman
- Department of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, P.O. Box 3660 Postal code 11481, Saudi Arabia
| | - Mohammd Alsanea
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Riyadh, P.O. Box 3660 Postal code 11481, Saudi Arabia
| | - Mohammed Asiri
- Department of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, P.O. Box 3660 Postal code 11481, Saudi Arabia
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Riyadh, P.O. Box 3660 Postal code 11481, Saudi Arabia
| | - Riyadh Alhedaithy
- Department of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, P.O. Box 3660 Postal code 11481, Saudi Arabia
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Riyadh, P.O. Box 3660 Postal code 11481, Saudi Arabia
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Wakeford W, Ioannidis D. Nasal obstruction in a 14 year old girl caused by a huge middle turbinate mucocele appearing radiologically as an inverted papilloma. J Radiol Case Rep 2023; 17:29-33. [PMID: 38098962 PMCID: PMC10718309 DOI: 10.3941/jrcr.v17i8.4774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2023] Open
Abstract
Introduction We present a case of a fourteen year old girl who presented with a large intra-nasal mass to the ENT team at a district general hospital in the UK. Presentation of case The girl presented predominantly with nasal obstruction and some symptoms of allergic rhinitis. Imaging revealed a large lesion abutting the skull base and causing bony remodelling with marked septal deviation. Based both on CT and MRI imaging, the reporting (non-head and neck) radiologist suggested inverted papilloma as a differential diagnosis. Intra-operative exploration in fact revealed a very large left middle turbinate mucocele extending to the left frontal sinus. The mass was excised endoscopically without complications. Discussion Although concha bullosa of the middle turbinate of the nose are common, development of a mucocele within them is far less common and for such a mucocele to develop to this size in a child is extremely rare. The egg shell lining of the lesion can be a tell-tale sign of their aetiology when taken alongside other radiological factors. This case highlights challenges in radiological diagnosis of intra-nasal masses in children, which can lead to delays and increased anxiety. Conclusion When assessing nasal masses in children it is important to keep a wide differential due to the challenges of diagnosis. A close conversation should be had with local head and neck radiologists and, of course, where there is a unilateral nasal mass tissue sampling is essential and may be taken as part of a full excision where clinically indicated.
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Affiliation(s)
- William Wakeford
- ENT Specialty Registrar, ENT Department, Colchester Hospital, East and North Essex NHS Foundation Trust, Colchester, UK
| | - Dimitrios Ioannidis
- Consultant ENT Surgeon, ENT Department, Colchester Hospital, East and North Essex NHS Foundation Trust, Colchester, UK
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Sun SJ, Chen AP, Wan YZ, Ji HZ. Endoscopic nasal surgery for mucocele and pyogenic mucocele of turbinate: Three case reports. World J Clin Cases 2022; 10:12007-12014. [PMID: 36405261 PMCID: PMC9669871 DOI: 10.12998/wjcc.v10.i32.12007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Revised: 09/18/2022] [Accepted: 10/20/2022] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND Cases of turbinate mucocele or pyogenic mucocele are extremely rare. During nasal endoscopy, turbinate hypertrophy can be detected in patients with turbinate or pyogenic mucocele. However, in many instances, differentiating between turbinate hypertrophy and turbinate mucocele is difficult. Radiological examinations, such as computed tomography (CT) or magnetic resonance imaging (MRI), are essential for the accurate diagnosis of turbinate mucocele. Herein, we report three cases of mucocele or pyogenic mucocele of turbinate, including their clinical presentation, imaging findings, and treatments, to help rhinologists understand this condition better.
CASE SUMMARY Three cases of turbinate and pyogenic mucocele were encountered in our hospital. In all patients, nasal obstruction and headache were the most common symptoms, and physical examination revealed hypertrophic turbinates. On CT scan, mucocele appeared as non-enhancing, homogeneous, hypodense, well-defined, rounded, and expansile lesions. Meanwhile, MRI clearly illustrated the cystic nature of the lesion on T2 sequences. Two patients with inferior turbinate mucocele underwent mucocele lining removal, while the patient with pyogenic mucocele underwent endoscopic middle turbinate marsupialization. The patients were followed up on the first, third, sixth month, and 1 year after discharge, and no complaints of headache and nasal congestion were reported during this period.
CONCLUSION In conclusion, both CT and MRI are helpful in the diagnosis of turbinate or pyogenic mucocele. Additionally, endoscopic nasal surgery is considered to be the most effective treatment method.
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Affiliation(s)
- Shu-Juan Sun
- Department of Otolaryngology-Head and Neck Surgery, Shandong Provincial ENT Hospital, Shandong University, Jinan 250022, Shandong Province, China
| | - Ai-Ping Chen
- Department of Otolaryngology-Head and Neck Surgery, Shandong Provincial ENT Hospital, Shandong University, Jinan 250022, Shandong Province, China
| | - Yu-Zhu Wan
- Department of Otolaryngology-Head and Neck Surgery, Shandong Provincial ENT Hospital, Shandong University, Jinan 250022, Shandong Province, China
| | - Hong-Zhi Ji
- Department of Otolaryngology-Head and Neck Surgery, Shandong Provincial ENT Hospital, Shandong University, Jinan 250022, Shandong Province, China
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Almutairi D, Alosaimi A, Alsurayhi A, Altalhi A. Infected Concha Bullosa Mucocele: A Case Report. Cureus 2022; 14:e22538. [PMID: 35345693 PMCID: PMC8956281 DOI: 10.7759/cureus.22538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/22/2022] [Indexed: 11/20/2022] Open
Abstract
Concha bullosa (CB) is a common sinonasal anatomic variant. The obstruction of a CB, though rare, might result in mucocele that may be misdiagnosed. In this report, we present a case of a 32-year-old female with a one-year history of unilateral nasal obstruction, headache, facial pain, foul nasal discharge, and hyposmia, initially misdiagnosed as a neoplasm. Computed tomography (CT) and magnetic resonance imaging (MRI) revealed a right middle CB infection with a mucocele. Laboratory cultures yielded Pseudomonas aeruginosa. Endoscopic sinus surgical mass excision was performed, and treatment with oral cefuroxime was administered. The patient recovered fully. A CB mucocele, though rare, should be considered in the differential diagnosis of an intranasal mass.
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Abstract
OBJECTIVE In what follows, it is extremely rare for the inferior turbinate to occur with a mucocele. The authors aim to evaluate the characteristics, clinical features, and treatment outcome of the inferior turbinate mucocele in our hospital. PATIENTS AND METHODS Five patients with radiologically confirmed inferior turbinate mucocele between January 2006 and December 2017 were enrolled in this study. RESULTS Out of the 5 patients with inferior turbinate mucocele reviewed, 2 out of the 5 patients had symptoms of nasal obstruction and headache respectively, whereas the other 3 remaining patients were found incidentally by radiological examinations without any nasal symptoms. Four patients were performed the surgery by the transnasal endoscopic marsupialization. One patient had a very small size of an inferior turbinate mucocele and had no symptoms, and in that case the authors decided to do a periodic observation without a surgical intervention. There were no major complications resulting from this surgical intervention, and no recurrence of the inferior turbinate mucocele. CONCLUSIONS The inferior turbinate mucocele is an extremely rare disease and can be diagnosed accurately by the use of radiologic examinations. The prevailing discipline is that endoscopic marsupialization is the best treatment for the inferior turbinate mucocele, which is known for showing very good results without recurrence of the condition.
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Affiliation(s)
- Dong Hoon Lee
- Department of Otolaryngology-Head and Neck Surgery, Chonnam National University Medical School and Chonnam National University Hwasun Hospital, Jeonnam, South Korea
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Buzi C, Micarelli I, Paine RR, Profico A, Messineo D, Tafuri MA, Manzi G. Digital imaging techniques applied to a case of concha bullosa from an early medieval funerary area in central Italy. INTERNATIONAL JOURNAL OF PALEOPATHOLOGY 2020; 31:71-78. [PMID: 33096378 DOI: 10.1016/j.ijpp.2020.10.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 10/02/2020] [Accepted: 10/02/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVE Concha bullosa is a rather common condition of the nasal turbinates, rarely reported in archaeological skeletal collections. This paper examines a case of concha bullosa as seen in a female cranium from a burial in central Italy, dated to the Longobard domination in the Peninsula (mid-7th- early 8th century CE). MATERIALS The individual under investigation (T86/17) comes from the funerary area of Selvicciola, located near the town of Viterbo in northern Latium, Italy. METHODS The skeleton was macroscopically examined. We analyzed the CT-scans of the defect by applying innovative R-based virtual tools. RESULTS It was possible to calculate the inner volume of the concha bullosa and to provide a 3D visual assessment of its shape. CONCLUSIONS Its size and shape suggest that the individual had this condition for a considerable period of time, during which its presence may have had affected her daily activities and health status. SIGNIFICANCE An under-represented paleopathological defect is examined for the first time through a virtual approach aimed at visualizing its shape and the assessment of its volume. New methods of 3D based virtual assessment can increase the informative value of defects. SUGGESTIONS FOR FURTHER RESEARCH Techniques used in this assessment should be considered as an evaluative tool for other conditions when macroscopic and radiographic imaging are limited.
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Affiliation(s)
- Costantino Buzi
- Department of Environmental Biology, Sapienza University of Rome, Piazzale Aldo Moro 5, 00185, Roma, Italy
| | - Ileana Micarelli
- Department of Environmental Biology, Sapienza University of Rome, Piazzale Aldo Moro 5, 00185, Roma, Italy.
| | - Robert R Paine
- Department of Environmental Biology, Sapienza University of Rome, Piazzale Aldo Moro 5, 00185, Roma, Italy
| | - Antonio Profico
- PalaeoHub, Department of Archaeology, University of York, Wentworth Way, YO105DD, York, UK
| | - Daniela Messineo
- Department of Radiological, Oncological, and Anatomo-Pathological Sciences, Sapienza University of Rome, Viale del Policlinico, 155, 00161, Roma, Italy
| | - Mary Anne Tafuri
- Department of Environmental Biology, Sapienza University of Rome, Piazzale Aldo Moro 5, 00185, Roma, Italy
| | - Giorgio Manzi
- Department of Environmental Biology, Sapienza University of Rome, Piazzale Aldo Moro 5, 00185, Roma, Italy
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Hu S, Helman S, Filip P, Cabin J, Colley P. The role of the otolaryngologist in the evaluation and management of headaches. Am J Otolaryngol 2019; 40:115-120. [PMID: 30523783 DOI: 10.1016/j.amjoto.2018.07.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2018] [Accepted: 07/05/2018] [Indexed: 01/03/2023]
Abstract
BACKGROUND Headaches are commonly evaluated in otolaryngology and often represent a diagnostic dilemma. This review addresses rhinogenic headache as well as trigeminal neuralgia and migraine, both of which can masquerade as sinus headache and whose management increasingly involves otolaryngology intervention. Discussion considers diagnostic criteria and novel therapies and derives an algorithm for clinical decision-making. DATA SOURCES OVID MEDLINE, Cochrane Library, and Google Scholar databases. METHODS A literature search was performed to identify relevant articles published in the past 10 years addressing the diagnosis and management of rhinogenic headache, trigeminal neuralgia and/or migraine. FINDINGS Rhinogenic headache: Identification of the specific cause must be achieved before treatment. No studies have mentioned the effect of certain therapies on the amelioration of headache. New techniques of balloon dilation for sinusitis are controversial, and their use remains contingent on surgeon preference. Removal of mucosal contact points has been shown to benefit quality of life in patients with contact point headache. Trigeminal neuralgia: Microvascular decompression is considered the gold standard for treatment, but percutaneous therapies can be effective for achieving pain control. Migraine: Patients who report amelioration of symptoms after targeted botulinum toxin injection may benefit from definitive decompression or nerve avulsion. Patients with mucosal contact points may have less favorable outcomes with migraine surgery if they are not simultaneously addressed. CONCLUSIONS A comprehensive understanding of the diagnostic workup and therapeutic options available for common headache etiologies is key to the management of a patient presenting with headache attributed to a rhinogenic cause.
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Fuglsang M, Sørensen LH, Petersen KB, Bille J. 10-year-old with concha bullosa pyogenic mucocele. BMJ Case Rep 2018; 2018:bcr-2018-224417. [PMID: 29764849 DOI: 10.1136/bcr-2018-224417] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
A 10-year-old girl presented with episodes of migraine. A nasal mass was found randomly during work-up. Interpreted as an osteoma, the mass was removed during endoscopic surgery. However, the histopathological examination turned out to be a pyomucocele in the right middle turbinate, which is an extremely rare yet benign condition in children.
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Affiliation(s)
- Milos Fuglsang
- Department of Ear Nose and Throat, University Hospital Aarhus, Aarhus, Denmark
| | | | | | - Jesper Bille
- Department of Ear Nose and Throat, University Hospital Aarhus, Aarhus, Denmark
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