Reformation of concha bullosa following treatment by crushing surgical technique: Implication for balloon sinuplasty

Authors

  • David A. Kieff MD,

    1. Harvard Vanguard Medical Associates, Boston, Massachusetts, U.S.A.
    2. Department of Otology and Laryngology, Harvard Medical School, Boston, Massachusetts, U.S.A.
    3. Department of Otolaryngology–Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, U.S.A.
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  • Nicolas Y. Busaba MD, FACS

    Corresponding author
    1. Department of Otology and Laryngology, Harvard Medical School, Boston, Massachusetts, U.S.A.
    2. Department of Otolaryngology–Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, U.S.A.
    3. Division of Otolaryngology, VA Boston HealthCare System, Boston, Massachusetts, U.S.A.
    • Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, 243 Charles Street, Boston MA 02114
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  • Presented as a poster at the Triological Society Eastern Section Meeting, Boston, Massachusetts, U.S.A., January 23–25, 2009. It received first prize for poster presentation at that meeting.

  • This work was done at the Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, U.S.A.

Abstract

Objectives/Hypothesis:

There are various surgical techniques designed to treat conchae bullosae (CB). These include partial or total resection and crushing. Frontal sinus balloon sinuplasty is thought to work by the crushing/remodeling of the agger nasi and frontal recess air cells. The long-term outcome of sinuplasty in the frontal/ethmoid air cell region is unknown. To date, no study has been done on the reformation of CB after crushing. We report on the long-term outcome of a series of patients who underwent crushing of their CB and suggest implications for frontal sinus balloon sinuplasty.

Study Design:

Retrospective case series.

Methods:

Retrospective review of 10 patients who re-presented with CB as a component of their nasal obstructive symptoms despite previously undergoing crushing of their CB. Data analyzed included paranasal sinus computed tomography (CT) scans and operative reports.

Results:

These 10 patients re-presented with recurrent rhinosinusitis and nasal obstructive symptoms. The patients had previously undergone septoplasty surgery with crushing of the CB and were noted to have reformed the CB on their most recent sinus CT. The previous surgeries were preformed from 2 to 15 years prior to their representation.

Conclusions:

CB can reform following crushing technique. One may extrapolate that agger nasi and frontal recess air cells may reform following balloon sinuplasty leading to recurrent obstruction of the frontal sinus outflow tract. Laryngoscope, 2009

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