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Mucocoele of the inferior turbinate: a case report
YBJOM-5014;
No. of Pages 2
ARTICLE IN PRESS Available online at www.sciencedirect.com
ScienceDirect British Journal of Oral and Maxillofacial Surgery xxx (2016) xxx–xxx
Case report
Mucocoele of the inferior turbinate: a case report Yong Won Lee a,∗ , Yong Min Kim b a
Department of Otorhinolaryngology-Head and Neck Surgery, Veterans Health Service Daejeon Hospital, 147, Daecheong-ro 82beon-gil, Daedeok-gu, Daejeon 34314, Republic of Korea b Department of Otorhinolaryngology-Head and Neck Surgery, Chungnam National University School of Medicine, Daejeon, Republic of Korea Accepted 26 September 2016
The inferior turbinate is usually a single, solid bone that has developed as a separate entity. A pneumatised inferior turbinate (also known as inferior concha bullosa) is seldom seen, despite the widespread use of computed tomography (CT). Several studies have recently been published, but the mechanisms of its genesis and pathophysiology remain unclear.1–3 A mucocoele arising from it is extremely rare, and as far as we are aware, has been reported only once before.4 We describe one that was confined to the lamellar segment of the inferior turbinate. A 65-year-old man presented with left nasal obstruction that had not responded to treatment for several months, and he had no other symptoms or relevant history. The only pertinent finding on nasal endoscopic examination was that his left inferior turbinate was enlarged and adherent to his septum (Fig. 1). CT examination of the paranasal sinuses showed a 2.6 × 2.2 cm, well-defined, homogeneous, non-enhancing, expansile, cystic lesion in the inferior turbinate (Fig. 2). The lesion was confined to the vertical lamella and the bulbous segment was intact. We found that the ipsilateral middle and superior turbinates and the contralateral superior turbinate were also affected. We operated endoscopically under general anaesthetic. The bony wall was noticeably thinned and easily dissected from the cyst. We resected the lateral wall, preserved the medial wall and its mucosa, and drained off the clear yellow mucus. When we had identified the patent nasolacrimal duct by massaging the lacrimal sac, we out-fractured the turbinate and put it in place after synechiolysis. We did not touch the ipsilateral middle turbinate. His symptoms disappeared as he
∗
Corresponding author. Tel.: +82 42 939 0342; fax: +82 42 939 0567. E-mail address: [email protected] (Y.W. Lee).
Fig. 1. Preoperative photograph of the enlarged left inferior turbinate and adhesion to the nasal septum.
recovered, and there was no recurrence during 22 months of follow up. Mucocoeles in turbinates are unusual and most have been found in the middle one, where pneumatisation is common and essential to their development. In 1995, Namon described one that seemed to arise from the bulbous type of pneumatisation,4 but we thought that our patient’s lesion had arisen from the lamellar segment, with preservation of the bulbous segment and no connection with the sinus. The cause of obstruction of the natural ostium is unknown because the patient did not mention any relevant past history. The synechia between the septum and the turbinate was probably a consequence of the expansion of the mucocoele. From this case we can assume that pneumatised inferior turbinates have a normal mucociliary function similar to other air cells of the middle turbinate and paranasal sinuses.5
http://dx.doi.org/10.1016/j.bjoms.2016.09.015 0266-4356/© 2016 The British Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.
Please cite this article in press as: Lee YW, Kim YM. Mucocoele of the inferior turbinate: a case report. Br J Oral Maxillofac Surg (2016), http://dx.doi.org/10.1016/j.bjoms.2016.09.015
YBJOM-5014;
ARTICLE IN PRESS
No. of Pages 2
2
Y.W. Lee, Y.M. Kim / British Journal of Oral and Maxillofacial Surgery xxx (2016) xxx–xxx
Ethics statement/confirmation of patient’s permission This study was approved at each institution and consent was obtained from the patient. References 1. Ozcan KM, Selcuk A, Ozcan I, et al. Anatomical variations of nasal turbinates. J Craniofac Surg 2008;19:1678–82. 2. Oztürk A, Alatas¸ N, Oztürk E, et al. Pneumatization of the inferior turbinates: incidence and radiologic appearance. J Comput Assisted Tomogr 2005;29:311–4. 3. Yang BT, Chong VF, Wang ZC, et al. CT appearance of pneumatized inferior turbinate. Clin Radiol 2008;63:901–5. 4. Namon AJ. Mucocele of the inferior turbinate. Ann Otol Rhinol Laryngol 1995;104:910–2. 5. Bolger WE, Butzin CA, Parsons DS. Paranasal sinus bony anatomic variations and mucosal abnormalities: CT analysis for endoscopic sinus surgery. Laryngoscope 1991;101:56–64. Fig. 2. Computed tomogram showing the well-defined, homogeneous, nonenhancing, expansile, cystic lesion that was confined to the lamellar segment of the inferior turbinate. Note the preservation of an intact bulbous segment.
Conflict of interest We have no conflicts of interest.
Please cite this article in press as: Lee YW, Kim YM. Mucocoele of the inferior turbinate: a case report. Br J Oral Maxillofac Surg (2016), http://dx.doi.org/10.1016/j.bjoms.2016.09.015
No. of Pages 2
ARTICLE IN PRESS Available online at www.sciencedirect.com
ScienceDirect British Journal of Oral and Maxillofacial Surgery xxx (2016) xxx–xxx
Case report
Mucocoele of the inferior turbinate: a case report Yong Won Lee a,∗ , Yong Min Kim b a
Department of Otorhinolaryngology-Head and Neck Surgery, Veterans Health Service Daejeon Hospital, 147, Daecheong-ro 82beon-gil, Daedeok-gu, Daejeon 34314, Republic of Korea b Department of Otorhinolaryngology-Head and Neck Surgery, Chungnam National University School of Medicine, Daejeon, Republic of Korea Accepted 26 September 2016
The inferior turbinate is usually a single, solid bone that has developed as a separate entity. A pneumatised inferior turbinate (also known as inferior concha bullosa) is seldom seen, despite the widespread use of computed tomography (CT). Several studies have recently been published, but the mechanisms of its genesis and pathophysiology remain unclear.1–3 A mucocoele arising from it is extremely rare, and as far as we are aware, has been reported only once before.4 We describe one that was confined to the lamellar segment of the inferior turbinate. A 65-year-old man presented with left nasal obstruction that had not responded to treatment for several months, and he had no other symptoms or relevant history. The only pertinent finding on nasal endoscopic examination was that his left inferior turbinate was enlarged and adherent to his septum (Fig. 1). CT examination of the paranasal sinuses showed a 2.6 × 2.2 cm, well-defined, homogeneous, non-enhancing, expansile, cystic lesion in the inferior turbinate (Fig. 2). The lesion was confined to the vertical lamella and the bulbous segment was intact. We found that the ipsilateral middle and superior turbinates and the contralateral superior turbinate were also affected. We operated endoscopically under general anaesthetic. The bony wall was noticeably thinned and easily dissected from the cyst. We resected the lateral wall, preserved the medial wall and its mucosa, and drained off the clear yellow mucus. When we had identified the patent nasolacrimal duct by massaging the lacrimal sac, we out-fractured the turbinate and put it in place after synechiolysis. We did not touch the ipsilateral middle turbinate. His symptoms disappeared as he
∗
Corresponding author. Tel.: +82 42 939 0342; fax: +82 42 939 0567. E-mail address: [email protected] (Y.W. Lee).
Fig. 1. Preoperative photograph of the enlarged left inferior turbinate and adhesion to the nasal septum.
recovered, and there was no recurrence during 22 months of follow up. Mucocoeles in turbinates are unusual and most have been found in the middle one, where pneumatisation is common and essential to their development. In 1995, Namon described one that seemed to arise from the bulbous type of pneumatisation,4 but we thought that our patient’s lesion had arisen from the lamellar segment, with preservation of the bulbous segment and no connection with the sinus. The cause of obstruction of the natural ostium is unknown because the patient did not mention any relevant past history. The synechia between the septum and the turbinate was probably a consequence of the expansion of the mucocoele. From this case we can assume that pneumatised inferior turbinates have a normal mucociliary function similar to other air cells of the middle turbinate and paranasal sinuses.5
http://dx.doi.org/10.1016/j.bjoms.2016.09.015 0266-4356/© 2016 The British Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.
Please cite this article in press as: Lee YW, Kim YM. Mucocoele of the inferior turbinate: a case report. Br J Oral Maxillofac Surg (2016), http://dx.doi.org/10.1016/j.bjoms.2016.09.015
YBJOM-5014;
ARTICLE IN PRESS
No. of Pages 2
2
Y.W. Lee, Y.M. Kim / British Journal of Oral and Maxillofacial Surgery xxx (2016) xxx–xxx
Ethics statement/confirmation of patient’s permission This study was approved at each institution and consent was obtained from the patient. References 1. Ozcan KM, Selcuk A, Ozcan I, et al. Anatomical variations of nasal turbinates. J Craniofac Surg 2008;19:1678–82. 2. Oztürk A, Alatas¸ N, Oztürk E, et al. Pneumatization of the inferior turbinates: incidence and radiologic appearance. J Comput Assisted Tomogr 2005;29:311–4. 3. Yang BT, Chong VF, Wang ZC, et al. CT appearance of pneumatized inferior turbinate. Clin Radiol 2008;63:901–5. 4. Namon AJ. Mucocele of the inferior turbinate. Ann Otol Rhinol Laryngol 1995;104:910–2. 5. Bolger WE, Butzin CA, Parsons DS. Paranasal sinus bony anatomic variations and mucosal abnormalities: CT analysis for endoscopic sinus surgery. Laryngoscope 1991;101:56–64. Fig. 2. Computed tomogram showing the well-defined, homogeneous, nonenhancing, expansile, cystic lesion that was confined to the lamellar segment of the inferior turbinate. Note the preservation of an intact bulbous segment.
Conflict of interest We have no conflicts of interest.
Please cite this article in press as: Lee YW, Kim YM. Mucocoele of the inferior turbinate: a case report. Br J Oral Maxillofac Surg (2016), http://dx.doi.org/10.1016/j.bjoms.2016.09.015