The objective of this study was to determine the prevalence of concha bullosa and nasal septal deviation and their potential relationships to maxillary sinusitis. 883 CT scans taken at Creighton University School of Dentistry from 2005 to 2008 were retrospectively reviewed for the presence of concha bullosa, nasal septal deviation, and maxillary sinusitis. 67.5% of patients exhibited pneumatization of at least one concha, 19.4% of patients had a deviated septum, and 50.0% had mucosal thickening consistent with maxillary sinusitis. 49.3% of patients who had concha bullosa also had evidence of maxillary sinusitis. Only 19.5% of patients with concha bullosa also had nasal septal deviation, whereas 19.7% of patients with sinusitis also presented with nasal septal deviation. Although concha bullosa is a common occurrence in the nasal cavity, there did not appear to be a statistically significant relationship between the presence of concha bullosa or nasal septal deviation and maxillary sinusitis.
With the recent widespread introduction of cone beam computed tomography (CBCT), dentists and otolaryngologists are better able to identify anatomical abnormalities and pathological states within the structures of the nasal cavity and the surrounding paranasal sinuses. Previously used radiographic techniques were frequently less effective at identifying irregularities in the sinuses [
On each side of the nasal cavity, there exists a superior, middle, and inferior concha. It is widely believed that osteomeatal obstructions may impede ventilation and mucociliary clearance from the sinuses, predisposing affected patients to sinus disease [
A retrospective study was conducted of 883 CBCT scans taken between September 2005 and June 2008 at Creighton University School of Dentistry (Omaha, NE). This study was exempt from review by the Institutional Review Board. All scans were taken using an
Scans were reviewed for any nasal cavity and/or paranasal anatomical abnormalities, with specific evaluation on the presence of concha bullosa, deviated septa, and sinusitis of the maxillary sinuses. Concha bullosa was defined as the presence of pneumatization of any size within in the superior, middle, or inferior conchae. Septal deviation was defined as a deviation of greater than 4 mm from the midline. The presence of any radiographic mucosal thickening above the bony floor of the maxillary antrum was defined as abnormal [
Table
Age distribution of the male and female population.
Age range (years) | Gender | |
Male | Female | |
1–10 | 9 | 12 |
11–20 | 49 | 46 |
21–30 | 83 | 75 |
31–40 | 40 | 34 |
41–50 | 41 | 86 |
51–60 | 70 | 107 |
61–70 | 55 | 77 |
71–80 | 22 | 36 |
81–90 | 11 | 13 |
91–100 | 0 | 1 |
Mean | 42.8 | 46.7 |
Standard Deviation | 20.2 | 19.7 |
67.5% of the patient scans reviewed had evidence of pneumatization of the concha. From the 883 scans, 12.3% were located in one of the right conchae, 13.0% involving the left conchae, and 43.2% bilaterally distributed. The majority of concha bullosa were located in the middle concha; 7.8% on the right side, 8.3% left (Figure
Prevalence and gender distribution of concha bullosa, nasal septal deviation, and sinusitis.
Concha Bullosa | Nasal Septal Deviation | Sinusitis | ||||
Present | Absent | Present | Absent | Present | Absent | |
Total | 596 (67.5%) | 278 (31.4) | 171 (19.4%) | 712 (88.6%) | 442 (50.0%) | 441 (50.0%) |
Gender | ||||||
Male | 261 (68.3%) | 121 (31.7%) | 73 (18.9%) | 310 (81.2%) | 236 (61.8%) | 146 (38.2%) |
Female | 334 (67.8%) | 159 (32.3%) | 98 (19.9%) | 395 (80.1%) | 206 (41.8%) | 287 (58.2%) |
Coronal CT scan demonstrating the presence of left middle concha bullosa (arrow). No septal deviation or sinusitis is present. Note the size difference in the middle conchae, with the left middle concha larger than the right middle concha.
19.4% of patients had deviated septa (Figure
Coronal CT scan demonstrating left nasal septal deviation (arrow). No concha bullosa or sinusitis is evident.
A total of 50.0% of patients had evidence of maxillary sinusitis. There was a statistically significant higher prevalence of maxillary sinusitis in males (61.8%) compared to females (41.8%;
Coronal CT scan demonstrating bilateral maxillary sinusitis (arrows). The degree of sinus inflammation is more prominent in the right sinus. Concha bullosa or nasal septal deviation are not noted.
There was no statistical significance when comparing the relationship of patients with concha bullosa (67.6%) and those with sinusitis (41.8%). 49.3% of patients had a combination of both (Figures
Relationship of concha bullosa and sinusitis.
Concha Bullosa | |||
Present | Absent | ||
Sinusitis | Present | 294 (49.3%) | 148 (16.7%) |
Absent | 302 (50.7%) | 139 (15.7%) |
Coronal CT scan demonstrating right middle concha bullosa (superior arrow) and right maxillary sinusitis (inferior arrow). No nasal septal deviation is present. Note the difference in size of the right middle concha compared to the left middle concha.
Coronal CT scans demonstrating bilateral middle concha bullosa (superior arrows) with bilateral maxillary sinusitis (inferior arrows). Note that there is more mucosal thickening on the left floor of the maxillary sinus than the right sinus floor, whereas the right concha bullosa demonstrates a greater degree of pneumatization compared to the left concha bullosa.
Coronal CT scan demonstrating bilateral middle concha bullosa (superior arrows) in combination with bilateral maxillary sinusitis (inferior arrows). Note the left concha bullosa (right superior arrow) is located slightly superior to the left concha. There is similar degree of sinus inflammation in both maxillary sinuses.
The relationship between unilateral or bilateral concha bullosa and ipsilateral sinusitis was not statistically significant. Of the 109 patients with right concha bullosa, only 12.8% also had right maxillary sinusitis (
Relationship of right, left, or bilateral concha bullosa, compared to the presence of ipsilateral sinusitis.
Concha Bullosa | Ipsilateral Sinusitis present |
Right | 14/109 (12.8%) |
Left | 21/115 (18.3%) |
Bilaleral | 81/381 (21.3%) |
The relationship between the presence of concha bullosa and nasal septal deviation was not statistically significant. Of the 596 patients with concha bullosa, 19.5% also had deviation of the nasal septum (Figure
Relationship of concha bullosa and nasal septal deviation.
Concha Bullosa | |||
Present | Absent | ||
Septal Deviation | Present | 116 (19.5%) | 55 (19.2%) |
Absent | 480 (80.5%) | 116 (19.5%) |
Coronal CT scan demonstrating right middle concha bullosa (left arrow) and left nasal septal deviation (right arrow). No sinus inflammation is present. Also note the differences in shape of the concha: the right middle concha is larger than the left middle; the left inferior concha is larger than the right inferior concha.
Examining the potential relationship between sinusitis and nasal septal deviation, there was no statistical significance. 87 (19.7%) of the 442 patients with maxillary sinusitis also had nasal septal deviation (Figure
Relationship of concha bullosa and sinusitis.
Concha Bullosa | |||
Present | Absent | ||
Sinusitis | Present | 87 (19.7%) | 355 (80.3%) |
Absent | 84 (19.1%) | 357 (80.95%) |
Coronal CT scan demonstrating right nasal septal deviation and severe bilateral maxillary sinusitis. No concha bullosa is present. The left maxillary sinus has a greater degree of inflammatory involvement than the right sinus.
In our study, 67.5% of patients had concha bullosa, which is somewhat higher than other studies, in which the prevalence of concha bullosa varied from 35% to 53% [
19.4% of patients in our study had nasal septal deviation, which is significantly lower than Stallman’s 65% [
Sinusitis, which was defined in our study as any evident thickening of the mucosa in the maxillary sinus, occurred in 50.0% of our patient population. Bolger’s study [
While it has been suggested that abnormalities of the concha can predispose patients to obstruction of the sinuses, leading to chronic sinusitis [
While studies have suggested an association between septal deviation and the presence of concha bullosa [
Regarding any potential relationship between nasal septal deviation and sinusitis, Hatipoglu et al. [
We found no definitive relationship between the presence of concha bullosa or nasal septal deviation and the development of maxillary sinusitis.
The authors would like to thank Dr. Martha Nunn for her assistance in the statistical analysis of the paper.