From the Guidelines
No, it is not mandatory to perform a concha bullosa resection during turbinectomy. The decision to operate on a concha bullosa should be based on the patient's symptoms, the size of the concha bullosa, and its relationship to surrounding structures 1. When treatment is needed, options include partial turbinectomy, lateral lamellectomy, or crushing techniques that preserve the turbinate's physiological functions. The goal of any intervention is to relieve obstruction while preserving the important physiological functions of the turbinates, including humidification, warming of inspired air, and regulation of nasal airflow. Several surgical procedures are available for addressing inferior turbinate hypertrophy, and submucous resection with outfracture was found to be the most effective surgical therapy with the fewest complications in a prospective randomized study of 382 patients with inferior turbinate hypertrophy 1. Many asymptomatic concha bullosa are discovered incidentally on imaging and require no treatment. Treatment depends on whether the concha bullosa is causing symptoms or contributing to sinus disease. If a patient has a concha bullosa but experiences no symptoms or sinus issues related to it, no surgical intervention is necessary. Inferior turbinate reduction surgery is a reasonable option for those patients with inferior turbinate hypertrophy who have continued symptoms despite medical management or in those patients who cannot tolerate medical treatment 1. The choice of surgical procedure should be individualized based on the patient's specific anatomy and symptoms. It is essential to weigh the potential benefits of surgery against the potential risks and complications, and to consider the patient's overall health and medical history when making treatment decisions. Ultimately, the decision to perform a concha bullosa resection during turbinectomy should be made on a case-by-case basis, taking into account the individual patient's needs and circumstances.
From the Research
Turbinate Reduction and Concha Bullosa
- The relationship between turbinate reduction, specifically turbenectomy, and the necessity of addressing concha bullosa is complex and depends on various factors including symptoms and the extent of turbinate pneumatization.
- Studies have shown that concha bullosa, which is the pneumatization of the middle turbinate, can cause symptoms such as nasal obstruction, headache, and anosmia due to obstruction rather than the presence of olfactory mucosa in the turbinate itself 2.
- Surgical intervention, including lateral marsupialization for concha bullosa, has been shown to improve symptoms such as nasal obstruction and olfaction in patients with concha bullosa 2, 3.
- The decision to address concha bullosa during turbinate reduction surgery may depend on the presence and severity of symptoms, as well as the extent of turbinate pneumatization.
- In some cases, concha bullosa may be asymptomatic and not require surgical intervention, while in other cases, it may be a significant contributor to symptoms and require treatment 4, 5, 6.
Surgical Considerations
- Functional endoscopic sinus surgery (FESS) is a common approach for treating concha bullosa and other sinus disorders 3.
- The goal of surgery is to improve nasal drainage, reduce obstruction, and alleviate symptoms.
- The surgical approach may vary depending on the extent of turbinate pneumatization and the presence of other sinus disorders.
Diagnosis and Evaluation
- Computed tomography (CT) scans are a valuable tool in diagnosing concha bullosa and evaluating the extent of turbinate pneumatization 4.
- A thorough history and physical examination are also essential in evaluating patients with suspected concha bullosa.
- Olfaction tests and visual analog scales may be used to assess the impact of concha bullosa on olfaction and nasal obstruction 2.