Unilateral nasal breathing obstruction in childhood – an unusual cause

A concha bullosa is a pneumatised turbinate and is considered an anatomical variant without primary pathological value. It is primarily found in the middle turbinates (concha media bullosa). A deviated septum can be a secondary consequence. A 10-year-old female patient presented with left nasal obstruction and anterior rhinorrhoea that had been present for several months. Endonasal endoscopy revealed a palpably hard and indolent mass completely obstructing the left nasal cavity, covered with non-irritant, smooth mucosa. This displaced the right inferior concha laterally. An MRI of the paranasal sinuses showed a mucocele (33x16x40 mm) in the left nasal cavity. We performed an endonasal, endoscopic rhinoscopy. In the nasal cavity, a mucocele surrounded by thin bone like a shell was found. The finding was therefore a mucocele in a massively enlarged concha media bullosa obstructing the left nasal cavity. Resection (turbinoplasty) of the concha media bullosa was performed. It is particularly important to combine all the results (anamnesis, clinical examination and, if necessary, diagnostic imaging) and to recognise the inter-individual norm variants. A concha media bullosa is primarily without disease value of its own. It can gain pathological significance in combination with other anatomical variations or if it is particularly pronounced. A turbinoplasty of the concha media bullosa can be performed therapeutically while preserving the medial wall. With this method, most of the turbinate remains intact and stability is maintained.

Publication History

Article published online:
19 April 2024