Endoscopic turbinoplasty of concha bullosa: long term results

Surgical Treatment of Concha Bullosa: A Comparison of the Short-term Results of Crushing and Lateral Laminectomy with and without Mucosal Preservation

Pneumatized middle turbinate (Concha bullosa) is one of the commonest intranasal anatomical variants. Surgery is the effective method to control symptomatic concha bullosa, however, still no clear definition for the best surgical technique. The aim of our study to assess and compare the short-term outcomes of crushing and lateral laminectomy with and without mucosal preservation in the surgical treatment of symptomatic concha bullosa. Thirty patients who underwent concha bullosa surgery (a total of 42 conchae surgeries) were included in this prospective randomized study. Patients were allocated consecutively and equally into 3 groups: Group A (lateral laminectomy without mucosal preservation, n = 10), Group B (lateral laminectomy with mucosal preservation, n = 10) and Group C (Crushing, n = 10). Patients underwent the preoperative and postoperative visual analogue score (VAS) for nasal obstruction and headache, sinonasal outcome test-22 (SNOT-22) and olfactory detection test. All patients were arranged to postoperative reevaluation for 3 months. All groups showed strong significant improvement in VAS results, SNOT-22 and smell test between preoperative and postoperative scores (P < 0.001). There was a significant difference between the three groups only upon comparing lateral laminectomy groups with crushing group. No significant differences were detected between group A and B regarding all the evaluated variables. According to our results, lateral laminectomy was more advantageous than crushing in surgical management of concha bullosa. Moreover, lateral laminectomy without mucosal preservation was as effective as lateral laminectomy with mucosal preservation and there is no detectable difference between both techniques.

Effectiveness of Volumetric Reduction of Middle Concha Bullosa by Crushing Technique in Chronic Nasal Obstruction

To study the effectiveness of volumetric reduction of middle concha bullosa by crushing technique in chronic nasal obstruction cases on selection basis of 3Dimensional computed tomography measurements. Patients with complains of nasal obstruction underwent an Observational study. They were subjected to nasal endoscopy and computed tomography of paranasal sinuses with 3D size estimation of middle turbinate to confirm concha bullosa. 37 patients with unilateral/bilateral lesions were divided into 4 groups on the basis of ranged sizes. These were subjected to volume reduction by crushing technique with marsulizer under local/general anesthesia with necessary post-operative medications and the final outcomes were judged on basis for nasal endoscopy and computed tomography of paranasal sinus at 1 year. Out of 37 patients with total 42 concha bullosa, 5 had bilateral lesion. After crushing techniques, following results were obtained. In group A with pre-operative volume of concha between 0.60 and 0.80 ccm, 11 succeeded to achieve post-operative value of < 0.60 ccm. In group B, C, D with preoperative concha volume > 0.80 ccm all succeeded in achieving the post-operative value of < 0.60 ccm. 50% reduction in volume of concha occurred in 88% cases of group A and 100% in cases of other groups post-operatively at 1 year. Encouraging results with negligible consequences are ensued upon in case of chronic nasal obstruction due to concha bullosa by doing its volumetric reduction by crushing technique with marsulizer instrument.

Comparative Study Between Crushing Technique and Lateral Laminectomy of Middle Turbinate as Auxiliary Management in Patients Who Underwent Septoplasty with Concha Bullosa

The aim is to compare two commonly performed surgical techniques, lateral resection and crushing for Concha Bullosa (CB) as auxiliary management in patients who underwent septoplasty. In Patients diagnosed with DNS and CB, using endoscopy and Computerized Tomography, NOSE score was calculated. All patients underwent septoplasty and depending upon the surgical method followed for CB, patients allotted in two groups. In group A, crushing of middle turbinate was performed using Blakesley forceps and in group B, lateral resection of CB was done. Postoperative NOSE scores were calculated at 6 months and outcomes were compared. Both the surgical methods were highly effective in the management of CB. All patients had significant improvement in the NOSE score when compared with the preoperative values. Two patients in group B developed synechia between the turbinate and lateral wall. However, the superiority of  one method over the other could not be established statistically. CB is a common anomaly in anatomy of nose and paranasal sinus. It frequently coexists with DNS and may cause sinus problems if it is over-pneumatised. In such cases, surgical correction is warranted. Crushing of MT and lateral resection are two commonly performed methods, both are equally effective, but the crushing technique has an advantage of mucosal preservation and less postoperative complications.

An artificial intelligence algorithm that identifies middle turbinate pneumatisation (concha bullosa) on sinus computed tomography scans

OBJECTIVE

Convolutional neural networks are a subclass of deep learning or artificial intelligence that are predominantly used for image analysis and classification. This proof-of-concept study attempts to train a convolutional neural network algorithm that can reliably determine if the middle turbinate is pneumatised (concha bullosa) on coronal sinus computed tomography images.

METHOD

Consecutive high-resolution computed tomography scans of the paranasal sinuses were retrospectively collected between January 2016 and December 2018 at a tertiary rhinology hospital in Australia. The classification layer of Inception-V3 was retrained in Python using a transfer learning method to interpret the computed tomography images. Segmentation analysis was also performed in an attempt to increase diagnostic accuracy.

RESULTS

The trained convolutional neural network was found to have diagnostic accuracy of 81 per cent (95 per cent confidence interval: 73.0-89.0 per cent) with an area under the curve of 0.93.

CONCLUSION

A trained convolutional neural network algorithm appears to successfully identify pneumatisation of the middle turbinate with high accuracy. Further studies can be pursued to test its ability in other clinically important anatomical variants in otolaryngology and rhinology.

Comparison of the Effects of 2 Surgical Techniques Used in the Treatment of Concha Bullosa on Olfactory Functions

INTRODUCTION

Concha bullosa (CB), which is pneumatization of the concha, is one of the most commonly seen anatomic variations of the lateral nasal wall.

OBJECTIVE

To investigate the effects on olfactory function of lateral turbinectomy and crushing methods used in the surgical treatment of CB.

METHODS

The study included a total of 47 patients operated on for a diagnosis of CB and nasal septum deviation. The patients comprised 22 females and 25 males, with bilateral CB in 18 cases and unilateral in 29 cases. Intervention was made to a total of 65 CB. The cases were separated as those applied with septoplasty and lateral turbinectomy in group 1 (n = 34) and those applied with the septoplasty and crushing method in group 2 (n = 31). The olfactory function of the patients was evaluated preoperatively and at 3 months postoperatively with the Brief Smell Identification Test.

RESULTS

A statistically significant increase was determined in the postoperative smell test results compared with the preoperative values in both group 1 (P = .021) and group 2 (P = .001). When the change in the smell test results from preoperative to postoperative was compared between the groups, the increase in group 2 was determined to be statistically significantly greater (P = .002).

CONCLUSION

The results of this study showed that the crushing method in surgical treatment of CB increased olfactory functions more than the lateral resection method, and as the improvement in olfactory functions was greater, this demonstrated that only increasing the nasal cavity is not sufficient and the nasal mucosa should be protected as far as possible.

Correction of deviated nose

Deviated nose deformities have always been a surgical challenge, and it is essential to achieve both functional and esthetic improvements. Various techniques have evolved over time to correct deviated noses but no one method applies in all cases. Successful correction requires a complete understanding of the various surgical techniques and concepts, including the three-dimensional nasal structure and the time-related changes to surgically-treated noses.

Comprehensive review on endonasal endoscopic sinus surgery

Endonasal endoscopic sinus surgery is the standard procedure for surgery of most paranasal sinus diseases. Appropriate frame conditions provided, the respective procedures are safe and successful. These prerequisites encompass appropriate technical equipment, anatomical oriented surgical technique, proper patient selection, and individually adapted extent of surgery. The range of endonasal sinus operations has dramatically increased during the last 20 years and reaches from partial uncinectomy to pansinus surgery with extended surgery of the frontal (Draf type III), maxillary (grade 3-4, medial maxillectomy, prelacrimal approach) and sphenoid sinus. In addition there are operations outside and beyond the paranasal sinuses. The development of surgical technique is still constantly evolving. This article gives a comprehensive review on the most recent state of the art in endoscopic sinus surgery according to the literature with the following aspects: principles and fundamentals, surgical techniques, indications, outcome, postoperative care, nasal packing and stents, technical equipment.

Anatomical correlation between existence of concha bullosa and maxillary sinus volume

PURPOSE

The objective of this study was to assess the effects of concha bullosa variation on maxillary sinus volume and uncinate angle.

METHOD

The study group included 169 patients (338 sides) who underwent either surgical or medical treatment with the diagnosis of chronic rhinosinusitis. The paranasal sinus computed tomography of these patients was analyzed to measure maxillary sinus volume, uncinate angle and existence of concha bullosa. Subsequently, these variables were evaluated to find out possible relationship inbetween.

RESULTS

Mean maxillary sinus volume and uncinate angle at right and left sides were 15.21 ± 0.47 and 15.51 ± 0.48 mm(3), 30.57 ± 0.62° and 30.20 ± 0.68°, respectively. There was no difference between patients with or without concha bullosa in regard to maxillary sinus volume and uncinate angle at both sides. Maxillary sinus volume and degree of uncinate angle did not show any significant correlation at both sides; r = -0.124, p = 0.107 and r = -0.136, p = 0.078.

CONCLUSION

In conclusion, concha bullosa is a common anatomical variation at nasal cavity. The existence of concha bullosa does not have any association with the volume of maxillary sinus and angle of uncinate process.