Abstract
A 53-year-old man presented with long-standing nasal and sinus congestion that had begun after an untreated nasal injury had occurred 35 years earlier. Endoscopic nasal examination showed extensive nasal septal deflection into the left nasal passage (figure, A) and extreme enlargement of the right middle turbinate (figure, B and C). Computed tomography (CT) of the sinuses showed similar findings (figure, D) with a markedly enlarged right middle turbinate that was not pneumatized.
The patient underwent nasal septal reconstruction. At the time of this surgery, partial resection of the right middle turbinate also was carried out to allow midline placement of the deviated septum. Postoperatively, the patient's airway improved bilaterally.
The hypertrophy of the right middle turbinate in this case was not due to a concha bullosa, as evidenced by the middle turbinate's lack of pneumatization. It appears that because this patient's nasal septum was markedly deflected to the left, hence enlarging the right airway artificially over the previous 35 years, the right middle turbinate had an unusually large space in which to expand. Compensatory hypertrophy of the inferior turbinate is frequently seen when there is significant shifting of the nasal septum to the opposite side of the nose; compensatory hypertrophy of a middle turbinate, however, is less common. 1
A: Telescopic view (4 mm, 0°) of the left nasal cavity reveals extensive nasal septal deflection into the left nasal passage with a small middle turbinate. B and C: Examination of the right nasal cavity shows the extreme enlargement of the right middle turbinate in a larger nasal cavity. D: Coronal CT scan of the paranasal sinuses shows marked septal deviation to the left with a markedly enlarged right middle turbinate and with a much smaller left middle turbinate. Some mucosal thickening in the floor of the maxillary sinuses is noted.