Massive Concha Bullosa with Secondary Maxillary Sinusitis

Clinical and Experimental Otorhinolaryngology Vol. 1, No. 4: 221-223, December 2008
DOI 10.3342/ceo.2008.1.4.221
Case Report
Massive Concha Bullosa with Secondary
Maxillary Sinusitis
Joong Seob Lee, MD
Il Ju Ko, MD
Han Dong Kang, MD
Hun Suk Lee, MD
Department of Otorhinolaryngology-Head and Neck Surgery, College of Medicine, Hallym University, Seoul, Korea
Concha bullosa is a common anatomic variation of the middle turbinate; however, sinusitis secondary to the concha bul-
losa is rare. A 52-yr-old woman presented with nasal obstruction and posterior nasal drip. Computed tomography and
examination of the nasal cavity revealed septal deviation on the left side, and a massive concha bullosa and maxillary
sinusitis on the right side. The lateral lamella of the affected turbinate was removed and the inspissated material was
drained. Histopathologic examination of the excised lesion in the concha bullosa revealed bacterial colonies in the mucus
plug. We report here on a massive concha bullosa with secondary maxillary sinusitis.
Key Words. Massive concha bullosa, Sinusitis
INTRODUCTION
Computed tomography (CT) of the paranasal sinuses showed
a massive concha bullosa that bulged into the lateral nasal wall,
Concha bullosa is a cystic distension of the middle nasal concha.
with almost total obstruction of the maxillary sinus ostium (Fig. 1).
This variation of the middle turbinate is very common and vari-
In addition, right maxillary sinusitis was also observed. On the
ous studies have reporting the frequency of this as 14-53%.
endoscopic examination, the concha bullosa was pale and it could
However, polyps, mucocele formation, and infection in the con-
be mistaken as the inferior turbinate because it protruded ante-
cha bullosa are rare. There have been few reported cases since
rior to an inferior turbinate (Fig. 2A). On the operation, the lat-
Bektas et al. (1) first noted an instance of an infected concha bul-
eral and medial lamellae of the concha bullosa were separated
losa with orbital extention. There have been no reports about a
and the lateral lamella was then cut out. There was some yellow-
massive concha bullosa with definite secondary maxillary sinusi-
ish, inspissated material, and a polypoid lesion in the concha bul-
tis in the current literature. Here we describe a patient who has
losa (Fig. 2B). The yellowish, concentrated material was aspirat-
nasal obstruction and symptoms of post nasal drip due to a mas-
ed out and the polypoid lesion was sent to the Pathology Depar-
sive concha bullosa and the related sinusitis.
tment for further examination. Next, a middle meatal antrosto-
my was performed and a discharge of pus was observed through
the antrostomy site. A bacterial culture was performed with neg-
CASE REPORT
ative results. Histopathological examination of the excised lesion
from the concha bullosa revealed bacterial colonies in the mucus
A 52-yr-old woman was admitted to our clinic with complaints of
plug and lymphocytic infiltration, which were both consistent with
nasal obstruction and posterior nasal drip. She had suffered
chronic inflammation. The patient’s symptoms quickly diminished
with these symptoms for several months. On nasal examination,
postoperatively. The endoscopic examination that was done two
we noted the hypertrophic right middle turbinate and left septal
weeks after the operation showed a clear cavity.
deviation. The patient was allergic to aspirin and penicillin, and
she was a hepatitis B-viral carrier. She was otherwise healthy and
the routine laboratory results were all normal.
DISCUSSION
?Received April 23, 2008
A concha bullosa is an aerated middle turbinate. Pneumatization of
Accepted after revision June 26, 2008
the middle turbinate may originate from the frontal recess, the
?Corresponding author : Hun Suk Lee, MD
Department of Otorhinolaryngology-Head and Neck Surgery, Kang Nam
anterior ethmoids or directly from the middle meatus. In one report-
Sacred Heart Hospital, College of Medicine, Hallym University, 948-1
ed case, ventilation of the air cells within a concha bullosa came
Daerim 1-dong, Yeongdeungpo-gu, Seoul 150-950, Korea
from the area from which the pneumatization arose (2).
Tel : +82-2-829-5217, Fax : +82-2-842-5217
E-mail : oldstone@hallym.or.kr
A concha bullosa can be infected, and cases of massive con-
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Clinical and Experimental Otorhinolaryngology Vol. 1, No. 4: 221-223, December 2008
A
B
Fig. 1. Coronal & Axial CT of the paranasal sinus shows the right huge concha bullosa and maxillary sinusitis.
A
B
Fig. 2. Preoperative finding: telescopic view (0°, 4 mm) of the right nasal cavity shows the huge concha bullosa of the middle turbinate.
Intraoperative finding: after resection of lateral lamella of the concha bullosa, telescopic view (0°, 4 mm) shows that it is filled with yellowish, inspis-
sated material.
cha bullosa pyocele have been reported. The patient in our report
deviation (5). Consistent with this previous report, we think that
complained of no acute symptoms, but acute orbital symptoms
in this case, the septal deviation on the left side encouraged the
can be a sign of orbital extension (1).
development of a right concha bullosa.
There is conflicting data on whether or not concha bullosa is
In conclusion, we suggest that if a patient has an infected con-
a cause of sinusitis. Several studies have shown there is no rela-
cha bullosa with secondary maxillary sinusitis, resection of the
tionship between concha bullosa and sinusitis (3, 4). However,
lateral wall of the concha bullosa and endoscopic sinus surgery
in this case, there was a massive concha bullosa obstructing the
will be needed to properly treat this condition.
middle meatus, and this caused the right maxillary sinusitis.
Of interest is the relationship between the concha bullosa and
septal deviation. A study reported that septal deviation does not
REFERENCES
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