Anat Cell Biol.  2021 Jun;54(2):193-201. 10.5115/acb.20.247.

Prevalence of the anatomical variations of concha bullosa and its relation with sinusitis among Saudi population: a computed tomography scan study

• El-Din WAN
• Madani GA
• Fattah IOA
• Mahmoud E
• Essawy AS

• KMID: 2516903
• DOI: http://doi.org/10.5115/acb.20.247

Abstract

Concha bullosa (CB) is a pneumatic cavitation inside a concha in the nasal cavity. It is one of the most widely recognized nasal variations and is mostly found in the middle concha. CB is divided according to its site into three types; lamellar, bulbous and extensive. The goal of our study was to estimate the prevalence of CB among Saudi adult population and its association with sinusitis by using multidetector computed tomography (MDCT). This was a retrospective study carried out over a three-year period on 879 adult Saudi patients aged 18 years or older, referred for MDCT assessment of paranasal sinuses. Males were 540 and females were 339. Patients with facial congenital anomalies or nasal trauma were excluded from our study. CB was prevalent in both males and females among Saudi population (55.4%, 55.7%) respectively. Bilateral CB (55.5%) was more frequent than unilateral (44.5%). Extensive CB (44.0%) was the most frequent type. Sinusitis was associated more in patients with CB (48.0%) versus those who have no CB (5.9%). In conclusion, CB was prevalent among Saudi population and the most frequently recorded is the extensive type. Furthermore, the most common type associated with sinusitis was extensive CB (49.6%).

Keyword

Concha bullosa; Multidetector computed tomography; Saudi population; Sinusitis

Figure

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  Fig. 1 Types of concha bullosa (arrows): (A) lamellar type, (B) bulbous type, and (C) extensive type. (Illustrated by Nasr El-Din et al.).

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  Fig. 2 Relations between CB, side and sex. Values are presented as percentages. (A) Relation between the incidence of CB, side and sex. CB vs. absent CB according to sex chi-square P-value=0.912; unilateral CB vs. bilateral CB according to sex chi-square P-value=0.041, right CB vs. left CB according to sex chi-square P-value=0.033, right CB vs. bilateral CB according to sex chi-square P-value=0.003 and left CB vs. bilateral CB according to sex chi-square P-value=0.604. (B) Relation between the different types of CB and the side. Types of CB according to the side chi-square P-value=0.453. CB, concha bullosa.

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  Fig. 3 Different types of unilateral concha bullosa (CB) shown by coronal computed tomography images. (A) Right lamellar type CB (arrow). (B) Right bulbous CB (arrow). (C) Right extensive CB (arrow). (D) Left lamellar CB (arrow) with right maxillary sinusitis (arrowhead) and deviated nasal septum to right (asterisk). (E) Left bulbous CB (arrow). (F) Left extensive CB (arrow), with nasal septum deviation having a convexity to the right side (arrowhead).

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  Fig. 4 Different types of unilateral concha bullosa (CB) shown by axial computed tomography images. (A) Left large bulbous CB (arrow) with severe deviation of the nasal septum convexity to the right side (arrowhead). (B) Left lamellar CB (arrow). (C) Left extensive CB (arrow).

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  Fig. 5 Different types of bilateral concha bullosa (CB) shown by coronal (A, B) and axial (C, D) computed tomography images. (A) Bilateral lamellar type of CB (arrows). (B) Right lamellar (arrow) and left bulbous CB (arrowhead). (C) Right lamellar (arrow) and left extensive CB (arrowhead). (D) Right extensive CB (arrow) and left bulbous type (arrowhead).

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  Fig. 6 Relation between different types of CB and sex. Values are presented as number (percentage). Types of CB according to the sex chi-square P-value=0.693. CB, concha bullosa.

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  Fig. 7 Different types of concha bullosa (CB) associated with different types of sinusitis shown by coronal (A, C) and axial (D) computed tomography images. (A) Left bulbous CB (thin arrow), with deviated nasal septum (asterisk) to the right and solitary right ethmoidal sinusitis (thick arrow). (B) Moderate sized right extensive CB (arrow) with ipsilateral mucosal thickening in the maxillary sinus (MS). (C) Left extensive CB (thin arrow) with mild left frontal mucosal thickening (sinusitis) (arrowhead) associated with nasal septum deviation to right side (asterisk). Right bulbous CB is also noted (thick arrow). (D) Left bulbous CB (arrow) associated with sphenoid sinusitis (arrowhead) and deviated nasal septum to right side (asterisk).

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  Fig. 8 Pansinusitis in the same subject having concha bullosa (CB) shown by coronal (A) and axial (B) computed tomography images. (A) Right bulbous CB (thick arrow) with partial opacification denoting infected CB, bilateral ethmoidal (thin arrows) and bilateral maxillary sinusitis (arrowheads). Deviated nasal septum to left is also noted (asterisk). (B) Sphenoid (arrow) and bilateral ethmoidal (arrowheads) sinusitis.

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