The middle nasal concha is a bony projection from the ethmoid bone forming a curved shelf in the middle of the nasal cavity. It overlies the middle meatus and the ostiomeatal complex, the common drainage pathway for the frontal, maxillary, and anterior ethmoid sinuses. The concha bullosa is a pneumatised middle turbinate present in approximately 25-35% of individuals.
The middle nasal concha and the ostiomeatal complex beneath it are the central targets of functional endoscopic sinus surgery (FESS). Medialisation or resection of a pneumatised concha bullosa is often the first step in opening the ostiomeatal complex. The middle turbinate provides a landmark for the sphenopalatine foramen (lateral to its posterior attachment) where the sphenopalatine artery is ligated for posterior epistaxis. Aggressive middle turbinate resection risks anosmia and empty nose syndrome.
A pneumatised middle turbinate (concha bullosa) lateralises against the uncinate process and occludes the ostiomeatal complex, producing recurrent sinusitis that fails medical management; FESS with concha bullosa marsupialization or partial resection restores drainage and resolves the obstruction.
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