Huge Concha Bullosa and Septal Perforation: A Case Study

Document Type : Case Report

Authors

1 Otolaryngologist, Hearing research center, Ahvaz jundishapur university of medical sciences, Ahvaz, Iran

2 Department of Otolaryngology - Head and Neck Surgery, Imam Khomeini Hospital, Ahvaz Jundishapur University of Medical Science, Ahvaz, Iran.

3 Department of Otolaryngology - Head and Neck Surgery, Imam Khomeini Hospital, Ahvaz Jundishapur University of Medical Science, Ahvaz, Iran

Abstract

Introduction:
Concha bullosa is a usual anatomical variation of the nose and paranasal sinuses that can compromise their anatomy and function and cause such symptoms as headache, rhinosinusitis, and nasal congestion. Septal perforation is the defect of the septum that brings nasal cavities in communication and is usually caused by trauma. No septal perforation has been reported due to concha bullosa.
Case Report:
The case of this report was a 15-year-old female who presented with long-term nasal obstruction due to a huge concha bullosa in her right nasal cavity which perforated nasal septum. She lacked a history of any nasal septum surgery, drug abuse, cocaine, or long-term nasal spray. Endoscopic surgery was performed and our patient’s symptoms rapidly diminished after the surgery. Negative results were obtained for tuberculosis, Wegener’s granulomatosis disease, and malignancy.
Conclusion:
We believe that the concha bullosa presented in this case might have caused chondrocyte apoptosis due to mechanical pressure and led to septal perforation. Although uncommon, providers should be aware of the possibility of septal perforation in cases with concha bullosa when planning to perform surgery on patients with similar pathology.

Keywords


  1. Alromaih S, Hajr E. Huge nasal mass: Unusual presentation of a giant concha bullosa. Otolaryngology Case Reports. 2017;3.
  2. Doǧru H, Döner F, Uygur K, Gedikli O, Çetin M. Pneumatized inferior turbinate. American Journal of Otolaryngology. 1999;20(2):139-41.
  3. Yasar H, Verim A, Ozkul H. Bilateral Massive Conchae Bullosa Mimicking Intranasal Tumors. Ear, nose, & throat journal. 2005;84:510-1.
  4. Bahadir O, Imamoglu M, Bektas D. Massive concha bullosa pyocele with orbital extention. Auris, nasus, larynx. 2006 Jun;33(2):195-8.
  5. 5. Pereira C, Santamaría A, Langdon C, López-Chacón M, Hernández-Rodríguez J, Alobid I. Nasoseptal Perforation: from Etiology to Treatment. Current allergy and asthma reports. 2018 Feb;18(1):5.
  6. 6. Yildiz e, ulu s, kahveci. What are the Factors Leading to Nasal Septal Perforations after Septoplasty J Otolaryngol Rhinol 2019.
  7. Sonneveld KA, Sinha PK. Correction of Septal Perforation/Nasal Airway Repair. Oral Maxillofac Surg Clin North Am. 2020.
  8. Bolger WE, Butzin CA, Parsons DS. Paranasal sinus bony anatomic variations and mucosal abnormalities: CT analysis for endoscopic sinus surgery. The Laryngoscope. 1991 Jan;101(1 Pt 1): 56-64.
  9. Yun DH, Kim YJ, Kim JH, Lee BJ. Causes and Clinical Characteristics of the Nasal Septal Perforation. Journal of Rhinology. 2000 May; 7(1): 64-8.
  10. Zinreich SJ, Mattox DE, Kennedy DW, Chisholm HL, Diffley DM, Rosenbaum AE. Concha bullosa: CT evaluation. Journal of computer assisted tomography. 1988;12(5):778-84.
  11. Nikakhlagh S, Saki N, Saki G, Tahmasebi M, Davoodi M, et al. Anatomical Variations of Carotid Artery and Optic Nerve in Sphenoid Sinus Using Computerized Tomographic Imaging, Jentashapir J Cell Mol Biol. 2014 ; 5(6):e26658.
  12. Fornazieri MA, Moreira JH, Pilan R, Voegels RL. Perforation of Nasal Septum: Etiology and Diagnosis. Int. Arch. Otorhinolaryngol. 2010; 14(4): 467-471.
  13. Hanci D, Altun H. Comparison of Three Techniques for the Management of Concha Bullosa on Nasal and Olfactory Functions, International Journal of Otorhinolaryngology. 2018;. 4( 2): 39-45.
  14. Belli E, Rendine G, Mazzone N. Concha bullosa: endoscopic treatment. J Craniofac Surg 2009; 20:1165–1168.
  15. Jung DH, Chang GU, Shan L, Liu DL, Wang ZJ, Tian HJ, Chen C, Han WW. Pressure necrosis of septal cartilage associated with bilateral extended spreader grafts in rhinoplasty. Arch Facial Plast Surg. 2010 Jul-Aug;12(4):257-62.
  16. Braun H, Stammberger H. Pneumatisation of turbinates. Laryngoscope 2003; 113:668–672.