Polyp in concha bullosa: a case report and review of the literature

Concha bullosa is a cystic distension of the middle nasal concha. This is a common anatomic variation of the middle turbinate, however, polyp formation within concha bullosa is rare. The first documented case of polyp in concha bullosa was noted by Yanagisawa [1] in his book "The Atlas of Rhinoscopy: Endoscopic Sinonasal Anatomy and Pathology". Mirante et al. [2] reported the second case in a 38-year-old man. Here we describe a concha bullosa polyp in a 45-year-old man. The clinical presentation, radiological and endoscopic findings, and management approach for this case are discussed.A 45-year-old man presented to our clinic with complaints of nasal obstruction and headache. He had had these problems for 4 years. There was no history of nasal trauma or nasal allergy. Nasal examination revealed right septal deviation and a hypertrophic left middle concha. The patient was otherwise healthy and results of routine laboratory tests were normal. Computed tomography (CT) showed right septal deviation, left concha bullosa, and thickening of the mucosa on the inner aspect of the concha bullosa (Figure 1 left). Septoplasty was performed under general anesthesia and the lateral and medial lamellae of the concha bullosa were separated. The lateral lamella was excised and a polypoid mass originating from the inner mucosal surface of the concha bullosa was removed (Figure 1 right). Histopathologic examination of the mass revealed polypoid hyperplasia (Figure 2). The postoperative course was uneventful. Six months after the operation, the patient was free of nasal complaints.The middle turbinate lies medial to a number of important sinus structures, including the anterior ethmoid air cells, the maxillary sinus ostium, the nasofrontal duct, and the uncinate process. The average length of the middle concha in humans is 40 mm, and the average anterior and posterior thicknesses of this structure are 14.5 mm and 7 mm, respectively [3]. The turbinates help to warm, humidify and filter