Prevalence of the anatomical variations of concha bullosa and its relation with sinusitis among Saudi population: a computed tomography scan study

Distribution and laterality of concha bullosa in patients with different cranial skeletal types: a retrospective analysis among cases with concha bullosa

OBJECTIVE

Concha bullosa, a common anatomical variation characterized by air-filled cavities in the turbinate bones, can influence sinonasal function and surgical planning. This study aims to evaluate the distribution, laterality, and cranial skeletal type associations of concha bullosa (CB) among patients with confirmed CB findings on computed tomography (CT) scans.

METHODS

A retrospective cohort study was conducted on 774 patients who underwent cranial and facial CT scans between March 2023 and March 2024. Patients were classified into mesocephalic, brachycephalic, and dolichocephalic groups based on the cephalic index. The distribution and laterality of concha bullosa were assessed using CT scans, and statistical analyses were performed using the Chi-square test, with a significance level set at P < 0.05.

RESULTS

Among CB-positive patients, left-sided concha bullosa was most common (49.48%), followed by right-sided (31.91%) and bilateral (18.6%) involvement. Mesocephalic individuals constituted the largest proportion of CB-positive cases (55.56%), followed by dolichocephalic (22.86%) and brachycephalic (21.57%) individuals. A significant gender difference was observed in the mesocephalic (P = 0.001) and brachycephalic (P = 0.013) groups, with males exhibiting a higher prevalence of right-sided and bilateral concha bullosa.

CONCLUSION

Concha bullosa distribution varies significantly among cranial skeletal types among CB-positive patients, with mesocephalic individuals exhibiting the highest overall prevalence. Our findings underscore the influence of cranial morphology on the presentation of CB. This insight may enhance radiological evaluation and individualized surgical planning in CB-positive patients.

Concha Bullosa Mucopyocele- An Extremely Rare but Significant Differential Diagnosis for Unilateral Nasal Mass

Concha bullosa mucopyoceles are an extremely rare but important differential diagnosis for unilateral lateral masses. It may clinically and radiologically mimic sinonasal neoplasia. We are reporting such a case which presented as an expansile mass in the left nasal cavity associated with bony remodeling. It was managed by endoscopic sinus surgery.

Detection of concha bullosa using deep learning models in cone-beam computed tomography images: a feasibility study

BACKGROUND

Pneumatization of turbinates, also known as concha bullosa (CB), is associated with nasal septal deviation and sinonasal pathologies. This study aims to evaluate the performance of deep learning models in detecting CB in coronal cone-beam computed tomography (CBCT) images.

METHODS

Standardized coronal images were obtained from 203 CBCT scans (83 with CB and 119 without CB) from the radiology archives of a dental teaching hospital. These scans underwent preprocessing through a hybridized contrast enhancement (CE) method using discrete wavelet transform (DWT). Of the 203 CBCT images, 162 were randomly assigned to the training set and 41 to the testing set. Initially, the images were enhanced using a CE technique before being input into pre-trained deep learning models, namely ResNet50, ResNet101, and MobileNet. The features extracted by each model were then flattened and input into a random forest (RF) classifier. In the subsequent phase, the CE technique was refined by incorporating DWT.

RESULTS

CE-DWT-ResNet101-RF demonstrated the highest performance, achieving an accuracy of 91.7% and an area under the curve (AUC) of 98%. In contrast, CE-MobileNet-RF recorded the lowest accuracy at 82.46% and an AUC of 92%. The highest precision, recall, and F1 score (all 92%) were observed for CE-DWT-ResNet101-RF.

CONCLUSION

Deep learning models demonstrated high accuracy in detecting CB in CBCT images. However, to confirm these results, further studies involving larger sample sizes and various deep learning models are required.

Clinical anatomy of the paranasal sinuses and its terminology

Since its inception, the International Anatomical Terminology has been an indispensable and widely embraced resource for authors, anatomists, researchers, and medical professionals, ensuring standardized anatomical terminology across various disciplines. Nonetheless, it is widely acknowledged that periodic updates and enhancements are necessary to incorporate the latest scientific knowledge and advancements in imaging techniques. The current version of Terminologia Anatomica includes a section dedicated to the paranasal sinuses, encompassing ethmoidal cells and three sinuses: frontal, sphenoidal, and maxillary. However, the anatomical lexicon pertaining to the paranasal sinuses is more extensive. In clinical practice, multiple terms related to clinically significant structures are commonly employed. This article focuses on the clinical terminology associated with the paranasal sinuses, proposing significant extensions to the existing Terminologia Anatomica. These extensions aim to enrich the anatomical nomenclature and facilitate a harmonious convergence between the language of clinicians and the anatomical lexicon. Further endeavors should bridge the gap in anatomical nomenclature and improve communication between anatomists, researchers, and clinicians, thereby enhancing diagnostic accuracy and improving interdisciplinary research collaboration.

Giant concha bullosa presented as left nasal mass: a case report and literature review

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.

Bilateral enlarged concha bullosa: a case report and literature review

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.

Radiological anatomical variations of the lateral nasal wall and anterior skull base amongst different populations: A systematic review and meta-analysis

OBJECTIVES

To determine the anatomical variations of the lateral nasal wall and anterior skull base amongst populations in different geographical regions.

DESIGN

Systematic review and meta-analysis.

METHODS

Using PRISMA guidelines, SCOPUS and PUBMED databases were searched from inception until 1 March 2022. The regions and populations identified were from Europe, Asia, Middle East, Australia-New Zealand-Oceania, South America, North America and Africa. Random-effects model was used to estimate the pooled prevalence with 95% confidence intervals (CIs). Heterogeneity was assessed using the I2 statistic and Cochran's Q test.

MAIN OUTCOME MEASURES

Anatomical variations of the lateral nasal wall and anterior skull base confirmed by computed tomography scan.

RESULTS

Fifty-six articles were included with a total of 11 805 persons. The most common anatomical variation of the ostiomeatal complex was pneumatization of the agger nasi (84.1%), olfactory fossa was Keros type 2 (53.8%) and ethmoids was asymmetry of the roof (42.8%). Sphenoethmoidal and suprabullar cells have a higher prevalence in North Americans (53.7%, 95% CI: 46.00-61.33) while asymmetry of ethmoid roof more common in Middle Easterns (85.5%, 95% CI: .00-100). Bent uncinate process has greater prevalence in Asians while supraorbital ethmoid cells and Keros type 3 more common in non-Asians. The overall studies have substantial heterogeneity and publication bias.

CONCLUSION

Certain anatomic variants are more common in a specific population. The 'approach of analysis' plays a role in the prevalence estimates and consensus should be made in future studies regarding the most appropriate 'approach of analysis' either by persons or by sides.

Infected Concha Bullosa Mucocele: A Case Report

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.