Abstract

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Concha involving middle turbinate is a common occurence [1]. Review of literature puts the incidence anywhere between 14 – 40%. This is an interesting case report of mucocele involving middle turbinate concha. Pneumatization of middle turbinate is known as concha bullosa [4]. Concha bullosa actually is a radiological diagnosis [2]. Mucoceles can technically arise from a concha bullosa if its outflow channel is obstructed. This is ofcourse rather rare. This case report discusses a case of mucocele involving a pneumatized middle turbinate.

Introduction

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Mucocele is defined as a cyst without epithelial lining. This is actually a pathological definition. Ironically mucoceles involving paranasal sinuses do have a mucosal lining and hence are considered to be true mucous retention cysts caused due to obstruction to the normal drainage of glandular secretions [3]. Concha bullosa is caused by anterior ethmoidal air cell migration into the middle turbinate. When present this large air cell drains into the frontal recess area commonly. Bolger in his classic treatise divided concha bullosa into three groups [5]:
1. Lamellar type
2. Bulbous type
3. Extensive concha bullosa

Lamellar type of concha bullosa:
This is actually pneumatization of vertical lamella of the middle turbinate

Bulbous type of concha bullosa:
This is pneumatization of the bulbous portion of the middle turbinate

Extensive concha bullosa:
This involves pneumatization of both vertical and bulbous portions of middle turbinate. This is rather extensive form of concha and is commonly associated with septal deviation to the opposite side.

Case Report(s)

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32 years old female patient presented with complaints of:
* Left nasal cavity obstruction – 3 months duration
* Left sided head ache – 3 months
* She gave no history of bleeding from the nasal cavity.

Anterior rhinoscopy:
* Reddish mass could be seen occupying the entire left nasal cavity.
* Cough impulse was negative.
* Mass was sensitive to touch.
* Probe could be passed around the mass except laterally.

Discussion

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Eventhough the incidence of concha bullosa is rather common, it is rare for mucocele to occur in them. Studies reveal that concha bullosa has its own mucociliary clearance mechanisms. Commonly it drains into the frontal recess area and rarely via the lateral sinus. Any obstruction to their drainage channels can potentially lead to formation of mucoceles [6]. When infected these mucoceles can become pyoceles too [7].

Conclusion

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Eventhough concha bullosa is rather common, infections involving them leading to the formation of mucoceles are rather rare. CT imaging always clinches the diagnosis. This case is reported for its rarity and to create awareness about this condition.

References

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1. Sazgar AA, Massah J, Sadeghi M, et al. The Incidence of Concha Bullosa and the
Correlation with Nasal Septal Deviation. B-ENT 2008; 4(2): 87-91
2. Zinreich S J, Mattox DE, Kennedy DW, et al. Concha bullosa: CT evaluation. J Comput Assist Tomogr 1988;12:778-84
3. Balasubramanian Thiagarajan. Mucoceles of paranasal sinuses [Internet]. Version 26. Ent Scholar. 2012 Mar 7. Available from: http://entscholar.wordpress.com/article/mucoceles-of-paranasal-sinuses/.
4. Zinreich S, Albayram S, Benson M, Oliverio P. The ostiomeatal complex and functional endoscopic surgery. In: Som P, ed. Head and Neck Imaging. 4th ed. St Louis: Mosby,
2003; 149-173
5. Bolger WE, Butzin CA, Parsons DS. Paranasal sinus bony anatomic variations and mucosal abnormalities: CT analysis for endoscopic sinus surgery. Laryngoscope 1991; 101:56-64.
6. Unlu HH, Akyar S, Çaylan R, Nalça Y. Concha bullosa. J Otolaryngol 1994;23:23-7.
7. Lidov M, Som PM. Inflammatory disease involving a concha bullosa (enlarged pneumatized middle nasal turbinate): MR and CT appearance. AJNR Am J Neuroradiol 1990; 11:999-1001

Source(s) of Funding

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This article did not receive any external funding

Competing Interests

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Authors have no competing interests

Disclaimer

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