© Turkish Society of Radiology 2005
HEAD AND NECK IM AGING ??????????????????????
Concha bullosa types: their relationship with sinusitis, ostiomeatal and frontal recess disease
Hatice Gül Hatipoğlu, Mehmet Ali Çetin, Enis Yüksel
PURPOSE To assess the relationship among the concha bullosa types and sinusitis, ostiomeatal andfrontal recess disease. MATERIALS AND METHODS Computed tomography (CT) studies of 76 patients diagnosed with concha bullosa were reviewed retrospectively. All examinations were performed for evaluation of a symptom referable to sinonasal region. Concha bullosa cases were grouped according to the location of pneumatization of middle concha as lamellar, bulbous, and extensive. Each group was comparedaccording to sinus, ostiomeatal and frontal recess disease. We have assessed the location of ostium (frontal recess, air cells along the basal lamella, hiatus semilunaris) with respect to the types of concha bullosa. RESULTS There was not a significant relationship between concha bullosa types and sinus disease, ostiomeatal disease, and frontal recess disease (p>0.05). The location of ostium ofthe bulbous type was the hiatus semilunaris (p0.05 >0.05 >0.05
Table 2. Frequency of ostiomeatal disease in relation to concha bullosa types
OMDa (-) Lamellar Extensive Bulbous
OMD (+) 2 (8.33%) 12 (22.22) 6 (16.21%)
Total 24 54 37
p >0.05 >0.05 >0.05
22 (91.66%) 42 (77.77%) 31 (83.78%)
were used in the study. Images were obtained in the coronal planeusing 3 mm slice thickness from the anterior wall of the frontal sinus to the posterior wall of the sphenoid sinus. Scan parameters ranged between 120-160 kVp and 60-300 mA. Studies were interpreted in the bone window. Two radiologists performed the evaluations independently from each other; however, consensus was reached in conflicting cases. Radiological detection of mucoperiosteal thickening andopacification of the sinuses were regarded
as evidence of sinus disease. Mucous retention cysts were spared. Pneumatization of the middle concha was classified depending on the pneumatization of the lamellar and bullous portions of the middle concha as lamellar and bullous, respectively. Pneumatization of both the lamellar and bullous portions of the middle concha was classified as theextensive type. Mucosal thickening in the middle meatus was interpreted as ostiomeatal disease. Mucosal thickening in the frontal recess was defined as frontal recess disease. Conchae bul-
146 • September 2005 • Diagnostic and Interventional Radiology
Figure 3. On the coronal CT image, there is extensive type concha bullosa (asterisk) on the right and lamellar type on the left. Both drain into thefrontal recesses (fr) and both recesses are open (arrows). Both ostiomeatal units are open (dashed arrows).
Figure 4. Extensive type concha bullosa (asterisk) ostium drains into the air cells adjacent to the basal lamina (blk) on both sides (dashed arrows) on this coronal CT image. There is prominent mucosal thickening in the right maxillary sinus. Figure 5. Bulbous type concha bullosa(asterisk) is present on the right in this CT study. Right ostiomeatal unit is open (dashed arrows).
tical differences were found between the presence of disease in left and right frontal recesses and types of concha bullosa (p>0.05) (Figure 3). There were also no differences between types of concha bullosa and the presence of sinus disease on the same side (p>0.05) (Table 4). Discussion Concha bullosais the pneumatization of the concha and the most frequent variation of the sinonasal anatomy (1). It is most commonly encountered in the middle concha. It is rarely found in the superior and inferior conchae. Bolger et al. have divided
Volume 11 • Issue 3
the pneumatization of the middle concha into three groups: lamellar type is the pneumatization of the vertical lamella of the concha;...