The superior nasal concha is the smallest and most superior of the nasal turbinates, a bony projection from the ethmoid bone overlying the superior meatus. Above the superior concha lies the sphenoethmoidal recess into which the sphenoid sinus drains. The olfactory neuroepithelium is located in the superior nasal vault and superior concha mucosa.
The superior nasal concha is the reference for the sphenoethmoidal recess and sphenoid sinus ostium, accessed in endoscopic transsphenoidal surgery and for sphenoid sinus drainage in isolated sphenoiditis. The olfactory cleft between the superior turbinate and nasal septum is the site of olfactory receptor neurons, and its damage during aggressive FESS or nasal surgery risks anosmia. The supreme turbinate (fourth turbinate) may be present above the superior concha in approximately 60% of individuals.
Instrumentation or cauterisation in the superior nasal vault and olfactory cleft adjacent to the superior turbinate during FESS, nasal packing, or septal surgery damages olfactory neurons that do not regenerate, producing permanent anosmia that significantly affects quality of life.
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