The correlation between septal deviation and concha bullosa KEMAL UYGUR, MD, MUSTAFA TU ¨ Z, MD, and HARUN DOG ˘ RU, MD, C ¸ ayyolu-Ankara, Turkey OBJECTIVES: To investigate the incidence of con- cha bullosa (CB) in patients with septal deviation and the correlation between the angle of deviation and degree of pneumatization. STUDY AND DESIGN: This study was designed as a prospective trial. METHODS: Computerized tomography scans of the paranasal sinuses of 100 consecutive patients with the chief complaint of nasal obstruction and the diagnosis of septal deviation were taken. CB, sinus diseases, and septal deviation angles were re- corded. RESULTS: Angles of deviation ranged between 3 and 25 degrees (mean, 13.0  4.1 degrees). The mean of angle of deviation in cases with CB and in cases without CB was 13.0  4.0 and 13.0  4.2 degrees, respectively. No statistical difference was found between them (P > 0.05). Pneumatization of the contralateral CB was statistically significantly higher than that of ipsilateral CB (P < 0.05). Conclusion: Septal deviation does not appear to give rise to the formation of CB, but augments the pneumatization of the middle turbinate depending on the degree of deviation angle. (Otolaryngol Head Neck Surg 2003;129:33-6.) T he septum though a support structure of the nose is also important in the nasal physiology. It is formed by the quadrangular cartilage anteriorly, perpendicular lamina of ethmoid bone and vomer posteriorly. There is no standard definition of sep- tal deviation (SD), but it usually refers to convex- ities of the septum to one side with accompanying deformities of midline structures. SD is the most commonly seen deformity of the nose, which can be either congenital or acquired. The reported incidence is as 40% in a study conducted by computerized tomogaphy. 1 Concha bullosa or conchal pneumatization (CB) is the most common anatomic variation of osti- omeatal complex region that is generally seen in the middle turbinate, but also rarely in the superior turbinate. 2,3 A pneumatized inferior turbinate was reported in only 1 case in the literature. 4 The incidence rates for pneumatization of the middle turbinate is between 13.0 and 53.6%. 1,5-8 Although the exact mechanism of CB formation has not been elucidated, it is considered that the airflow pattern of the nasal cavity plays an impor- tant role. This theory is named as “e vacuo” and gives an explanation relevant to septal deviation. As the airflow is markedly diminished in the nasal cavity with convexity of the deviation, pneumati- zation of the middle turbinate is augmented in the contralateral site. No study has been encountered in the literature related to the incidence of CB in cases with septal deviation and the association between the deviation and CB. 9 The aim of this prospective study was to inves- tigate the incidence of CB in cases with septal deviation and the correlation between the angle of deviation and degree of pneumatization. METHODS Between April 1999 and April 2000, 100 con- secutive patients with the chief complaint of nasal obstruction and the diagnosis of septal deviation were enrolled in the study. Computerized tomog- raphy scans of paranasal sinuses were taken for each. CB, septal deviation, as well as sinus dis- eases were recorded. Deviation angles were cal- culated, and the most markedly deviated site was selected in “S” shaped deformities. CB were clas- sified according to Bolger et al 10 and named as bilateral unilateral and ipsilateral contralateral with respect to site of deviation. All concha pneu- matizations on the CT scans on which the concha pneumatization was the largest were measured in millimeters-squared compared with the ipsilateral orbital area in the same scan to standardize the From the Suleyman Demirel University School of Medicine, Ear, Nose, and Throat, Head and Neck Surgery Depart- ment. Reprint requests: Kemal Uygur, MD, B2 Blok, B Giris, D:4 Mesa C ¸ ayyolu Ankara-Turkey; e-mail, uygurkemal@ hotmail.com. Copyright © 2003 by the American Academy of Otolaryn- gology–Head and Neck Surgery Foundation, Inc. 0194-5998/2003/$30.00 + 0 doi:10.1016/S0194-5998(03)00479-0 33