Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2023 Mar:104:107919.
doi: 10.1016/j.ijscr.2023.107919. Epub 2023 Feb 7.

Endoscopic appearance of duplicated middle turbinate, case series and literature review

Abdulaziz Saud AlEnazi  1 , Shahad Ali Alzahrani  2 , Adnan Al-Samarah  3 , Mona MohammedSaleh Ashoor  4
Affiliations

Endoscopic appearance of duplicated middle turbinate, case series and literature review

Abdulaziz Saud AlEnazi et al. Int J Surg Case Rep. 2023 Mar.

Abstract

Introduction and importance: Duplication of the middle turbinate is an extremely rare condition encountered in rhinology clinic. Knowledge and awareness of the nasal turbinates' variations are important to perform a safe endoscopic surgery and evaluate patients with inflammatory sinus diseases.

Case presentation: Case series of two patients who visited rhinology clinic in academic university hospital. Case 1: presented with 6-month history of nasal blockage. Nasal endoscopy revealed bilateral duplication of the middle nasal turbinates. Computed tomography scans showed bilateral medially curved and anteriorly folded uncinate process, and right middle turbinate concha bullosa and its superior end of the middle turbinate was turned medially. Case 2: A 29-year-old gentleman presented with nasal obstruction mainly to the left side for several years. Nasal endoscopy showed bifid right middle turbinate and severe deviated nasal septum to the left. Upon imaging, a sinus computed tomography scan demonstrated a duplication of the right middle turbinates in the form of two middle nasal concha.

Clinical discussion: Different rare anatomical variations can occur at different points during the embryological development. These rare variations include double middle turbinate, accessory middle turbinate, secondary middle turbinate, and bifid inferior turbinate. The appearance of double middle turbinate can be encountered in rhinology clinic only 2 % of the time. Upon reviewing the literature, only few case reports were found regarding the double middle turbinate.

Conclusion: A double middle turbinate has important clinical implications. Anatomical variation may lead to narrowing in the middle meatus which makes the patient vulnerable to sinusitis or maybe associated with secondary symptoms. We report rare cases of middle turbinate duplication. Awareness of the nasal turbinates' variations is important for detection and management of inflammatory sinus diseases. Further studies are needed to identify the association of other pathology.

Keywords: Accessory turbinate; Duplication; Middle turbinate.

PubMed Disclaimer

Conflict of interest statement

Declaration of competing interest No conflicts of interest.

Figures

Fig. 1
Fig. 1
Endoscopic view of first case showing bilateral duplication of the middle turbinate. The right (A) and left (B) nasal cavities.
Fig. 2
Fig. 2
Coronal reformatted images [bone (A) and soft tissue (B) windows] of paranasal sinus demonstrates complete duplicated bilateral middle turbinates [Red arrows]. While the lateral [accessory] appears paradoxical in configuration. Note the large noninfected concha bullosa at the right middle turbinates [White arrow]. (For interpretation of the references to colour in this figure legend, the reader is referred to the web version of this article.)
Fig. 3
Fig. 3
Endoscopic view of the right nasal cavity (A and B). Endoscopic examinations show bifid right middle turbinate.
Fig. 4
Fig. 4
Coronal reformatted views for paranasal sinuses study [bone (A) and soft tissue (B) windows]. Demonstrates a duplication of the right middle turbinates in form of two middle nasal concha [arrows].
See this image and copyright information in PMC

References

    1. Georgakopoulos B., Hohman M.H., Le P.H. StatPearls [Internet] StatPearls Publishing; Treasure Island (FL): 2022 Jan. Anatomy, head and neck, nasal concha. [Updated 2021 Nov 19] Available from: https://www.ncbi.nlm.nih.gov/books/NBK546636/ - PubMed
    1. Viswanatha Borligegowda, Haridas Suprabha, Vijayashree Maliyappanahalli, Somshekhar Abhilasha, Vemanna Praveena. Rare anatomical variations of nasal turbinates: a prospective study. Res.Otolaryngol. 2017;6(5):59–63. doi: 10.5923/j.otolaryn.20170605.01. - DOI
    1. Choi Jeong Hwan. Frontal sinusitis caused by first and second secondary middle turbinates co-existing with an accessory middle turbinate. Jpn. J. Radiol. 2013;31(5):352–356. doi: 10.1007/s11604-013-0188-6. - DOI - PubMed
    1. Al-Qudah Mohannad A. Extra middle turbinate lamellas: a suggested new classification. Surg. Radiol. Anat. 2015;37(8):941–945. doi: 10.1007/s00276-015-1435-6. - DOI - PubMed
    1. Sedaghat Ahmad. Chronic rhinosinusitis. Am. Fam. Physician. 2017;96(8):500–506. - PubMed