Concha bullosa surgery and the distribution of human olfactory neuroepithelium

Abstract

In bullous middle turbinate surgery, controversy exists over which side of the bullous middle turbinate should be removed, as the distribution of human olfactory neuroepithelium is unclear. This study evaluated whether the middle turbinate tissue of patients undergoing endoscopic concha bullosa surgery contains functional olfactory epithelium. This prospective clinical study was conducted in tertiary referable center. It detected 70 conchae bullosa in 48 patients with sinonasal symptoms, who underwent paranasal computed tomography (CT) that showed pneumatization of the middle concha. All samples were obtained under general anesthesia. Three samples were obtained from each bullous middle turbinate: one each from the anterior, medial, and lateral portions. The mucosa from each sample was stained with olfactory marker protein (OMP). In total, 210 middle turbinate samples were taken from 48 patients during endoscopic surgery for conchae bullosa. The patients were 22 females and 26 males. Of the 70 conchae bullosa, OMP-stained nerve tissue was found in the lateral, anterior and medial aspects of 57 (81.4 %), 42 (60.0 %) and 23 (32.8 %) of the bullous middle turbinates, respectively. OMP-stained nerve tissue was found in 122 (58.1 %) of the 210 bullous middle turbinate tissue samples. OMP-stained nerve tissue was found on the lateral surface of the bullous middle turbinate more often than the medial surface. Therefore, during the concha bullosa surgery, OMP-stained nerve tissue found at least in the medial part of concha, suggested that the opening of the medial part of middle concha.

Comparison of two partial middle turbinectomy techniques for the treatment of a concha bullosa

“…Smell function is essential for enjoying life, personal mood behavior, and even cautionary alerts . There are still questions to be answered concerning in which parts of the middle turbinate olfactory neurofibers exist …”

Surgıcal Techniques for the Treatment of Concha Bullosa: A Systematic Review

“…It is known that middle turbinate has a role in the olfactory function and the precise anatomical distribution of olfactory neuroepithelium is unknown. Although, there are many studies on the olfactory epithelium of nasal cavity, only Apuhan et al 4 studied olfactory epithelium of concha bullosa and found more nerve tissues on a lateral surface of concha. Recent studies show that olfactory mucosa is distributed more anteriorly and inferiorly than previously described dorsoposterior and also is presented in the surface epithelium of the lower medial surface of the middle turbinates.…”

Concha bullosa

“…It is important to know for endonasal surgery that the olfactory neuroepithelial is situated within the olfactory cleft of the nasal cavity and extends to the upper portion of the nasal septum and onto the superior and middle turbinates to varying degrees [2]. Apuhan et al [1] had found olfactory nerve tissue at least in the medial part of the middle concha bullosa than the other parts of concha in their research and they suggest to open medial part of the concha bullosa in concha bullosa surgery. We agree with their opinion.…”

“…To the Editor, We read the article titled ''Concha bullosa surgery and the distribution of human olfactory neuroepithelium'' which was written by Apuhan et al [1] in your journal. It is a good clinical research.…”