A patient presenting with concha bullosa in another concha bullosa: a case report

A 53-year-old Caucasian woman was admitted to our clinic with complaints of nasal breathing difficulties and headache persisting for a long time. Another concha bullosa was detected in the middle concha bullosa on preoperative paranasal computed tomography examination. It is known that the paranasal sinuses have a number of anatomical variations.Herein we report a rare case, along with a review of the literature, to emphasize that a concha bullosa inside another concha bullosa should not be ignored.The importance of the paranasal sinus anatomy and its variations has been emphasized, along with the extensive use of coronal paranasal sinus computed tomography (CT) and endoscopic sinus surgery (ESS). The paranasal anatomy should be exposed in detail prior to ESS to develop treatment strategies during the operation and to prevent possible complications. Attention should be paid to these variations during radiological and endoscopic evaluation of the paranasal sinus anatomy. Concha bullosa is the pneumatization of the middle turbinate and is one of the anatomic variations of the paranasal region [1,2]. Concha bullosa can be either unilateral or bilateral and generally occurs together with a septal deviation to the contralateral side.Although inferior and superior conchae bullosa have been reported in the literature, this entity is quite rare. The ethmoidal bulla is an anterior ethmoidal sinus cell. Its size, shape and site of drainage may vary among patients. The incidence of middle concha bullosa ranges from 13% to 53% [1,2] and varies according to type. The incidence of bilateral middle concha bullosa has been reported to vary between 45% and 61.5% [1-3]. Herein we present the case of a patient with a large ethmoid bulla extending into a giant middle concha bullosa, which we designate as compound concha bullosa.A 53-year-old Caucasian woman was admitted to our clinic with the complaints of nasal breathing difficulties and headache of long duration. She did not have a h