Nasal Septal Deviation and Concha Bullosa – Do They Have an Impact on Maxillary Sinus Volumes and Prevalence of Maxillary Sinusitis?

Abstract

SummaryBackgroundThe aim of the study was to assess if the presence of nasal septal deviation and concha bullosa is connected with the development of sinuses and the incidence of inflammation within them.Material/MethodsWe retrospectively analysed 214 patients who underwent paranasal sinus computed tomography. There were 125 females and 89 males, the mean age being 47.67±16.74 years (range 18–97). Exclusion criteria included: age under 18 years, prior sinonasal surgery and S-shaped septum.ResultsMean volume of the right maxillary sinus was 17.794 cm3, while for the left one it was 17.713 cm3. Nasal septal deviation was found in 79.9% of computed tomography examinations and concha bullosa was observed in 42.1% of the patients’ examinations. There was an association between the presence of unilateral or dominant concha bullosa and contralateral direction of septal deviation [right-sided (p=0.039), left-sided (p=0.003)]. There was higher incidence of bilateral maxillary sinusitis in patients with septal deviation (p=0.007). Bilateral concha bullosa did not influence the incidence of bilateral maxillary sinusitis (p=0.495). Neither septal deviation (right sided: p=0.962; left-sided: p=0.731), nor unilateral/dominant concha bullosa (right: p=0.512; left: p=0,430) affected the asymmetry in volumes of maxillary sinuses. Bilateral concha bullosa was connected with larger volume of maxillary sinuses (right sinus: p=0.005; left sinus: p=0.048).ConclusionsNasal septal deviation, contrary to concha bullosa, has influence on the development of maxillary sinusitis. There is a connection between the presence of concha bullosa and direction of septal deviation. Only bilateral concha bullosa affects maxillary sinus volumes.

Frequency of Nasal Septum Deviation and Concha Bullosa: Forensic Anthropological Implications

“…The present study showed the presence of septum deviation in 24.6% of cases; in the literature, frequencies of septum deviation varying from 9% to 80% have been presented, depending on the population and methodology 4,5,13,14,[16][17][18][19] . Some authors mention septum deviation as the most common anatomical alteration in the nasal cavity 18 .…”

“…Despite this wide range, most studies report a high frequency of NSD, so we suggest that such differences can be explained due to the methodology used. Most studies analyses image data from CT images of patients presenting clinical problems related to the nasal cavity 5,8,10,13,14 . The literature also reports a robust association between nasal concha hypertrophy and the side to which the nasal septum is diverted 1,4,11,13,14 .…”

“…Bony changes in the nasal cavity such as nasal septum deviation (NSD) and concha bullosa are easy to identify and can be very applicable to forensic anthropology. NSD is a variance of the nasal septum that can occur due to different etiologies such as irregular osseous development, trauma, or overgrowth of the nasal concha; this contributes to nasal obstruction and may lead to some level of facial deformity [3][4][5] .…”

“…However, the exact mechanisms of CB formation remain unclear; some authors suggest that the airflow pattern has an important influence. CB alters the nasal cavity space, its size and shape, blocking the nasal sinus apertures and leading to an obstructive respiratory disorder with clinical relevance [4][5][6][7][8][9] .…”

Turbinoplasty of concha bullosa: a useful adjunct in improving nasal airway

“…10 The prevalence of concha bullosa is about 35%. 11,12 Although most ENT surgeons perform an outpatient endoscopy of the nose to look for synchronous pathology, the most common obstructive pathology which could be missed is the concha bullosa. This is best identified on a computed tomography scan of paranasal sinuses and is hence a radiological diagnosis.…”