Anatomical Variations of Nasal Turbinates

Abstract

After the widespread use of endoscopic sinus surgery and paranasal sinus computed tomography, many variations of nasal turbinates have been described. In addition to the most common one-middle turbinate pneumatization (concha bullosa)-superior and inferior turbinate pneumatizations have also been described. Secondary and accessory middle turbinates that can mimic real middle turbinate are anomalies described in recent years. Paradoxical middle turbinate and bifid inferior turbinate are very rarely encountered anomalies and can be easily recognized in paranasal tomography but can be overlooked by endoscopical examination. In the present study, the computed tomography images of 384 patients were evaluated for nasal turbinate variations, as well as their relations to mucosal pathologies. The most frequent variation was found to be concha bullosa; the least frequent one was found to be bifid inferior turbinate. In 1 of our patients, 5 of the 6 turbinates were found to have pneumatization, which is extremely rarely encountered in the literature. In this study, the prevalence of the variations of the turbinates and their association with chronic rhinosinusitis were investigated.

The Impact of Middle Turbinate Concha Bullosa on the Severity of Inferior Turbinate Hypertrophy in Patients with a Deviated Nasal Septum

“…15 If one allowed some outlier data, the prevalence is likely in the range of 21%-53%. [15][16][17][18][19][20][21][22][23][24][25][26][27] Some of the reported variability can be attributed to differences in the populations being evaluated, the type of evaluation (ie, CT versus surgery), and the definition of concha bullosa (ie, whether to include small lamellar types). Similar to ITH, a preponderance of published reports support a strong association between the presence of concha bullosa and NSD, in which the nasal septum typically bows toward the contralateral side and may increasingly do so when middle turbinate pneumatization is greatest.…”

Bifid inferior turbinate: a report of two cases

“…Other variations are secondary and accessory turbinates and paradoxical middle turbinate that can mimic middle turbinate, and bifid inferior turbinate which is an extremely rare condition. Ozcan et al [1] retrospectively evaluated paranasal sinus CT scans of 384 patients admitted to their clinic with various nasal complaints. They found concha bullosae in 185 patients (48.1%), pneumatization of superior turbinate in 47 (12.2%), pneumatization of inferior turbinate in nine (2.2%), paradoxical middle turbinate in 35 (9.1%), secondary inferior turbinate in 55 (14.3%), accessory inferior turbinate in 26 (6.8%) and bifid inferior turbinate in one patient (1%).…”

“…The most common variation of the lateral nasal wall are pneumatizations of turbinates. [1] Bifid inferior turbinate is an extremely rare condition. There are only four reported cases of bifid inferior turbinate in the literature.…”

CBCT Imaging of Paranasal Sinuses and Variations

“…The incidence of the secondary middle turbinate is reported to be between the 2 and 14.3% [17,19,40,41]. Secondary middle turbinate originates from the lateral nasal wall, and posterior part of the middle meatus and lamina papyracea may be damaged during the surgical operation for it [41].…”