The incidence of concha bullosa, unusual anatomic variation and its relationship to nasal septal deviation: A retrospective radiologic study

Abstract

Objective: Identifying anatomical variations associated with pathological findings is very useful for diagnoses and therapeutics. We conducted a study to detect various anatomical variations (superior, middle, inferior turbinate concha bullosa, uncinate bulla and nasal swell body [NSB]) in connection with nasal septal deviation.

Methods: This study used a retrospective radiological design to analyze 594 (1188 sides) osteomeatal computed tomography scans from 494 male patients and 100 female patients aged between 17 and 75 years. We randomly selected 100 male and 100 female patients as controls; we compared the groups and performed a statistical analysis. All patients in the control group had sinusitis only (i.e., they lacked nasal septal deviations).

Results: Left-sided septal deviation was found to be slightly more prevalent than right-sided deviation (43.9% and 36.4%, respectively). The incidence of S-curved septal deviation was 18.5%, that of dorso-ventral deviation was 10.9%, and that of caudal-rostral deviation was 7.6%. The incidence of only septal spur was 1.2%. In the case of middle turbinate concha bullosa, the incidence of the unilateral type was 17.3% and that of the bilateral type was 36.4%. In superior turbinate concha bullosa, the incidence of the unilateral type was 11.3% and that of the bilateral type was 27.4%. The incidence of inferior turbinate concha bullosa was 1.0% and that of uncinate bulla was 1.7%. NSB was found in 25.1% of patients, 24.7% of males and 27.0% of females. The frequencies of middle and superior concha bullosa were about 10-12 fold higher on the concave side. The nasal septal deviation group exhibited a higher incidence of most anatomical variants than the non-deviated group; differences in the middle turbinate concha bullosa attained statistical significance.

Conclusion: The radiologist must focus on anatomical variants in the preoperative evaluation. It is important for surgeons to be aware of these variations.

Keywords: Anatomic variation; Computed tomography; Nasal septum; Turbinate.