Bifid and secondary superior nasal turbinates
Abstract
The lateral nasal wall contains the nasal turbinates (conchae) which are used as landmarks during functional endoscopic surgery. Various morphological pos- sibilities of turbinates were reported, such as bifidity of the inferior turbinate and extra middle turbinates, such as the secondary middle turbinate. During a retrospective cone beam computed tomography study of nasal turbinates in a patient we found previously unreported variants of the superior nasal turbina- tes. These had, bilaterally, ethmoidal and sphenoidal insertions. On the right side we found a bifid superior turbinate and on the left side we found a secondary superior turbinate located beneath the normal/principal one, in the superior nasal meatus. These demonstrate that if a variant morphology is possible for a certain turbinate, it could occur in any nasal turbinate but it has not been yet observed or reported.
Keywords: nasal fossanasal conchabifid turbinatesecondary turbinatesphenoethmoidal recess
References
- Aksungur EH, Biçakçi K, Inal M, et al. CT demonstration of accessory nasal turbinates: secondary middle turbinate and bifid inferior turbinate. Eur J Radiol. 1999; 31(3): 174–176.
- Al-Qudah MA. Extra middle turbinate lamellas: a suggested new classification. Surg Radiol Anat. 2015; 37(8): 941–945.
- Ariyürek OM, Balkanci F, Aydingöz U, et al. Pneumatised superior turbinate: a common anatomic variation? Surg Radiol Anat. 1996; 18(2): 137–139.
- Aykut M, Gümüsburun E, Müderrïs S, et al. The secondary nasal middle concha. Surg Radiol Anat. 1994; 16(3): 307–309.
- Chastain JB, Sindwani R. Anatomy of the orbit, lacrimal apparatus, and lateral nasal wall. Otolaryngol Clin North Am. 2006; 39(5): 855–864, v.
- Clerico DM. Pneumatized superior turbinate as a cause of referred migraine headache. Laryngoscope. 1996; 106(7): 874–879.
- Cobzeanu MD, Bâldea V, Bâldea MC, et al. The anatomo-radiological study of unusual extrasinusal pneumatizations: superior and supreme turbinate, crista galli process, uncinate process. Rom J Morphol Embryol. 2014; 55(3 Suppl): 1099–1104.
- Fidan V. Panconcha bullosa: new definition in the literature. J Craniofac Surg. 2012; 23(3): e253–e254.
- Gotlib T, Kuźmińska M, Sokołowski J, et al. The supreme turbinate and the drainage of the posterior ethmoids: a computed tomographic study. Folia Morphol. 2018; 77(1): 110–115.
- Kantarci M, Karasen RM, Alper F, et al. Remarkable anatomic variations in paranasal sinus region and their clinical importance. Eur J Radiol. 2004; 50(3): 296–302.
- Kiroglu AF, Cankaya H, Yuca K, et al. Isolated turbinitis and pneumatization of the concha inferior in a child. Am J Otolaryngol. 2007; 28(1): 67–68.
- Koo SK, Kim JD, Moon JiS, et al. The incidence of concha bullosa, unusual anatomic variation and its relationship to nasal septal deviation: A retrospective radiologic study. Auris Nasus Larynx. 2017; 44(5): 561–570.
- Lee JH, Koh SH. A variant form of bifid inferior turbinate. Ear Nose Throat J. 2011; 90(9): E33–E34.
- Lee SY, Bae KE, Lee HB, et al. Bilateral accessory inferior turbinates and secondary middle turbinates. Jpn J Radiol. 2012; 30(6): 530–532.
- Măru N, Rusu MC, Săndulescu M. Variant anatomy of nasal turbinates: supreme, superior and middle conchae bullosae, paradoxical superior and inferior turbinates, and middle accessory turbinate. Rom J Morphol Embryol. 2015; 56(3): 1223–1226.
- Orlandi RR, Lanza DC, Bolger WE, et al. The forgotten turbinate: the role of the superior turbinate in endoscopic sinus surgery. Am J Rhinol. 1999; 13(4): 251–259.
- Ozcan KM, Selcuk A, Ozcan I, et al. Anatomical variations of nasal turbinates. J Craniofac Surg. 2008; 19(6): 1678–1682.
- Rusu MC, Măru N, Săndulescu M, et al. Rare anatomic variation: true bifid inferior turbinate. Surg Radiol Anat. 2018; 40(2): 217–220.
- Rusu MC, Săndulescu M, Bichir C, et al. Combined anatomical variations: The mylohyoid bridge, retromolar canal and accessory palatine canals branched from the canalis sinuosus. Ann Anat. 2017; 214: 75–79.
- Sava CJ, Rusu MC, Săndulescu M, et al. Vertical and sagittal combinations of concha bullosa media and paradoxical middle turbinate. Surg Radiol Anat. 2018; 40(7): 847–853.
- Say P, Leopold D, Cochran G, et al. Resection of the inferior superior turbinate: does it affect olfactory ability or contain olfactory neuronal tissue? Am J Rhinol. 2004; 18(3): 157–160.
- Selcuk A, Ozcan KM, Ozcan I, et al. Bifid inferior turbinate: a case report. J Laryngol Otol. 2008; 122(6): 647–649.
- Spear SA, Brietzke SE, Winslow C. Bilateral bifid inferior turbinates. Ann Otol Rhinol Laryngol. 2003; 112(2): 195–196.
- Stammberger H. Functional endoscopic sinus surgery. BC Decker: Mosby, Philadelphia 1991.
- Toplu Y, Bayindir T, Karatas E, et al. All concha bullosa: an undefined abnormality of the lateral nasal wall. Indian J Otolaryngol Head Neck Surg. 2013; 65(1): 86–88.
- Tubbs RS, Loukas M, Shoja MM. Bergman's comprehensive encyclopedia of human anatomic variation. John Wiley & Sons, 2016 .
- Wang RG, Jiang SC. The embryonic development of the human ethmoid labyrinth from 8-40 weeks. Acta Otolaryngol. 1997; 117(1): 118–122.
- Yılmaz MS, Güven M, Akidil Ö, et al. Bifid inferior turbinate: a report of two cases. Kulak Burun Bogaz Ihtis Derg. 2014; 24(6): 357–360.