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Naso-Ethmoidal Angioleiomyoma: A Mini-Invasive Combined Endoscopic and Microscopic Surgical Approach.

Dr. Serdar Ceylon

Endoscopes have been routinely used for more than twenty five years in sinus surgery. Recent advancements in technology and developments in computerized tomography help us to visualize and demonstrate the variations of the lateral nasal wall. A rare giant concha bullosa, named as “complex concha bullosa”, invaginating to ethmoid bulla has been presented. Keywords: Concha bullosa; Ethmoid bulla; Anatomic variation Introduction As endoscopic sinus surgery has been used widely in sinus pathologies and advancements in computerized tomography technologies, the importance of the lateral nasal wall anatomy and its variations has been emphasized more commonly. In evaluation of endoscopic and radiological anatomy of paranasal sinuses attention must be paid to these variations. Concha bullosa which is an anatomical variation of paranasal region, is pneumatization of middle conchal bone. Concha bullosa can be uni- or bilateral and if it is unilateral, it is accompanied usually by a contralateral septal deviation. Ethmoid bulla is an anterior ethmoidal cell. Its size, shape and drainage may show differences among people. In this case we present a big ethmoid bulla invaginating into a giant concha bullosa. Case Presention A 49 year-old female patient was admitted to our clinic with complaints of nasal obstruction, facial pain and snoring. During anterior rinoscopy right sided septal deviation and left sided nasal mass with a smooth mucosal surface was noted. The mass was compatible with concha bullosa and almost completely obstructing the nasal cavity. We failed to perform nasal endoscopy to the left side. Paranasal sinus tomography in axial and coronal sections demonstrated a left sided big ethmoid bulla invaginating into a giant concha bullosa (Figure 1and 2). An endoscopic concha bullosa and ethmoid bulla resection with a septoplasty was performed. Patient’s complaints disappeared after surgery.