Vol.:(0123456789) 1 3 Surgical and Radiologic Anatomy https://doi.org/10.1007/s00276-018-1998-0 ANATOMIC VARIATIONS Vertical and sagittal combinations of concha bullosa media and paradoxical middle turbinate C. J. Sava 1  · M. C. Rusu 2  · M. Săndulescu 3  · D. Dincă 4 Received: 15 January 2018 / Accepted: 27 February 2018 © Springer-Verlag France SAS, part of Springer Nature 2018 Abstract Common anatomic variants of the middle nasal turbinate include its pneumatization (i.e. concha bullosa media) and its paradoxical curvature. We report here two cases of diferently combined variations of the middle turbinate which were documented in cone beam computed tomography (CBCT). The frst report presents the vertical combination of a double or septated lamellar concha bullosa with the paradoxical curvature of middle turbinate. This combined variant associated (coin- cidental fndings): ipsilateral paradoxical superior turbinate and contralateral paradoxical middle turbinate, concha bullosa superior and concha bullosa suprema. In the second case was found the sagittal combination of successive anterior concha bullosa media and posterior paradoxical curvature of the middle turbinate. An ethmoidal sinolith was found embedded in lamella basalis. The contralateral superior turbinate was pneumatized. These rare fndings demonstrate that sound knowledge of possible anatomical variations, supported by a complete use of the tools available for the CBCT documentation of cases, is able to enrich the picture of human anatomic variations, with a direct impact on clinical and surgical practice. The septa- containing lamellar concha bullosa and paradoxical middle concha combination is a variation that afects surgical practice. Keywords Anatomic variation · Nasal turbinate · Nasal fossa · Conchal pneumatization · Ethmoidal sinolith Introduction Nasal turbinates include Santorini’s one The nasal turbinates or conchae adhere to the nasal fossa lat- eral and/or superior nasal walls. The inferior nasal turbinate is an independent bone. The middle turbinate, the superior turbinate and the inconstant supreme one are ethmoidal tur- binates [21, 27]. The supreme nasal turbinate is the concha of Santorini, which was described by Giovanni Santorini in 1724 (quoted in [20]). Anatomic variations of the middle nasal turbinate are important in the pathogenesis of infam- matory processes of the paranasal sinuses [5]. Concha bullosa Concha bullosa is the term typically used to describe the pneumatization of the middle turbinate [1, 19, 24], which was variably found in 14–53% of individuals [13]. Pneu- matized inferior and superior turbinates were also reported [2, 9–11, 13, 14, 17], while the pneumatized concha of Santorini was previously reported only once [21]. Even the pneumatization of all nasal turbinates, called panconcha bul- losa, was described [13]. In these regards, the situs of turbi- nate pneumatization is better indicated by adding to concha bullosa one of the terms “inferior”, “media”, “superior” or “suprema”. The anterior segment of the middle nasal turbinate (con- cha) is a sagittal plate with a superior lamellar and an infe- rior bulbous segments [37]. As referred to these, three types of concha bullosa media were defned: lamellar, bulbous and true or extensive, the latter being the completely pneuma- tized anterior segment of the middle turbinate [7, 22, 37]. * M. C. Rusu anatomon@gmail.com 1 Division of Anatomy, Faculty of Medicine, “Victor Babeş” University of Medicine and Pharmacy, Timișoara, Romania 2 Division of Anatomy, Faculty of Dental Medicine, “Carol Davila” University of Medicine and Pharmacy, 8 Eroilor Sanitari Blvd., 050474 Bucharest, Romania 3 Division of Oral Implantology, Faculty of Dental Medicine, “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania 4 Department II of Surgical Clinical Divisions, Faculty of Medicine, “Ovidius” University, Constanţa, Romania