The “Structural Interplay”: Deviated Septal Angle and Pneumatization of Bulla - A Retrospective Study
Keywords:
Deviated nasal septum, Naso septal angle, Concha bullosa, middle turbinateAbstract
Introduction: Concha bullosa (CB) refers to the pneumatization of the concha, typically the middle turbinate. The precise mechanism of the CB remains ambiguous; nonetheless, the airflow pattern within the nasal cavity is deemed to be significant. The reduced airflow in the nasal cavity, due to the convexity of the deviation, results in increased pneumatization. While clinical practice findings typically support this, there is insufficient quantitative research validating the association between the angle of deviation and the degree of pneumatization.
Objective: 1. To estimate the association of concha bullosa in cases with septal deviation;
- To find the relationship between the angle of deviation and degree of pneumatization.
Methods: This is a retrospective study conducted in R.L. Jalappa Hospital conducted between Jan 2023-Nov 2024. Around 157 CT scans were studied by convenience sampling. Then nasal septal angle and Pneumatisation index was recorded. The data collected were analysed using Epi info 7.
Results: Among 157 paranasal CT scans analysed, the majority were males aged 20–40 years. Isolated septal deviation (29.9%) was the most common finding, followed by combined concha bullosa with septal deviation (24.8%). Laterality differences were significant, with unilateral CB predominating in CB + SD cases (P = 0.046). Mean septal deviation angles significantly differed across groups (P = 0.0001), while CBPI values showed no significant variation between subgroups.
Conclusion: Our study concludes that bilateral concha bullosa is common in isolated CB cases and unilateral CB is most common in CB with S.D cases. Also mean septal deviation is higher in unilateral septal deviation with CB compared to bilateral one.
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Tsai TL, Lan MY, Ho CY. There is no structural relationship between nasal septal deviation, concha bullosa, and paranasal sinus fungus balls. Sci World J. 2012;1:1–4. doi: 10.1100/2012/181246.
Carrasco VF, Maneva SM, Carreto AC, Guijarro BS, Gonzalez CO, Valle JD. Nasal septum anatomy and deviations: beyond straight and flat. Eur Soc Radiol. 2015 doi: 10.1594/ecr2015/c-1810.
Daghistani KJ. Nasal septal deviation in Saudi patients: a hospital based study. J KAU Med Sci. 2002;10:39–46.
Unlü HH, Akyar S, Caylan R, Nalça Y. Concha bullosa. J Otolaryngol. 1994 Feb;23(1):23-7. PMID: 8170015.
Stammberger H, Posawetz W. Functional endoscopic sinus surgery. Concept, indications and results of the Messerklinger technique. Eur Arch Otorhinolaryngol. 1990;247(2):63-76. doi: 10.1007/BF00183169. PMID: 2180446.
Uygur K, Tuz M, Dogru H. The correlation between septal deviation and concha bullosa. Otolaryngol Head Neck Surg. 2003; 129:33–36.
Stallman JS, Lobo JN, Som PM. The incidence of concha bullosa and its relationship to nasal septal deviation and paranasal sinus disease. AJNR Am J Neuroradiol. 2004; 25:1613–1618.
Yigit O, Acioglu E, Cakir ZA, Sisman AS, Barut AY. Concha bullosa and septal deviation. Eur Arch Otorhinolaryngol. 2010; 267:1397–1401.
Beryl, S., Ominde., Patrick, Sunday, Igbigbi. 4. The coexistence of concha bullosa and nasal septum deviation in adult Nigerians. Indian journal of health sciences and biomedical research KLEU, (2022). doi: 10.4103/kleuhsj.kleuhsj_379_21.
Smith KD, Edwards PC, Saini TS, Norton NS. The prevalence of concha bullosa and nasal septal deviation and their relationship to maxillary sinusitis by volumetric tomography. Int J Dent. 2010;2010:404982.
Kucybała I, Janik KA, Ciuk S, Storman D, Urbanik A. Nasal Septal Deviation and Concha Bullosa – Do They Have an Impact on Maxillary Sinus Volumes and Prevalence of Maxillary Sinusitis? Pol J Radiol. 2017 Mar 4;82:126–33.
Sazgar A, Massah J, Sadeghi M, Bagheri A, Rasool F. The incidence of concha bullosa and the correlation with nasal septal deviation. B-ENT. 2008;4:87-91.
Mubarki M, Shamakhi R, Daghriri R, Alzarei A, Hakami K. The degree of concha bullosa pneumatization and its association with severity of deviated nasal septum in patients of southern region in Saudi Arabia. Int J Otorhinolaryngol Head Neck Surg. 2021 Apr 23;7(5):717–20.
Calvo-Henríquez C, Mota-Rojas X, Ruano-Ravina A, Martinez-Capoccioni G, Lattomus K, Martin-Martin C. Concha bullosa. A radiological study and a new classification. Acta Otorrinolaringol Esp. 2019;70(3):145–50.
Wadhwa S, Sharma N, Garg U, Dutta P. Concha bullosa: types and relationship with chronic sinusitis. Int J Otorhinolaryngol Head Neck Surg. 2017 Jun 24;3(3):482–5.
Erkan SO. The relationship between septal deviation and concha bullosa. Turk J Ear Nose Throat. 2017 Jul 1;27(2):74–8....
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