The middle nose partition, which constitutes of cartilage and bone, seperating the nose into two cavities, namely left and right is called Septum.
Conchas are structures in the nose made of bone and soft tissue that extends from the nose's outer wall to the septum located in the middle central line in a half C-shape. There are 3, sometimes 4 of them in each left and right cavities. They are called as inferior, middle and superior conchas. In parallel with the nose's structure, the inferior concha is the biggest concha and the superior concha is the smallest concha. Contrary to the popular belief, concha is not the adenoid but is a structure with a different construction, location and function.
Conchas are of vital importance for many functions that nose performs. The duty of conchas is to slow down the air inhaled through the nose, make the air ready to enter into the lungs by heating it up to approximately 25 0C, moisturize it, remove foreign substances and particles and produce some enzymes.
Especially the middle concha's duty is to prevent the air inhaled through the nose from directly entering into the sinuses.
Conchas sometimes become bigger or smaller depending on the blood circulation during the inhalation process in order to fulfil their functions and protect the lungs. In this way, the air canals won’t become stabile and they will have a controllable dynamic structure that can adapt to outer factors.
In order to ensure for the cilia which protect the lungs from dirt, dust, virus, bacteria and toxins and filters the air to remain moisturized and not to dry up, becoming bigger and smaller are not done at the same time and in a synchronized way, but rather done in turns and shifts by both nasal cavities. This shift work ranging from 30 minutes to 6 hours is called the nasal cycle. Since total amount of the air inhaled does not change, people do not notice this difference. During the nasal cycle, one nasal cavity, i.e. air canal, enables little air to pass through it due to concha’s swelling, thereby enables the cilia to rest while the other one allows for a normal air flow.
Apart from enabling cilia to rest and keep moisturized, another purpose of the nasal cycle is to ensure a good sense of smell. Smelling is a phenomena related to the chemicals in the air inhaled. In order to perceive some chemicals' smell, they need to remain longer at the smell receptors. During the nasal cycle, smell of the chemicals in the slow-moving air in the closed nasal cavity is perceived better.
It is argued in the latest studies that there is also an effect of the nasal cycle even on psychological disorders such as Bipolar Disorder and Schizophrenia.
Concha Bullosa is the formation of air gaps, pneumatizations in the bone tissue of concha. It is the most common anatomic disorder in the lateral walls of the nose.
Although concha bullosa is rarely seen in the inferior and superior conchas, it is frequently seen in the middle concha. As in one side of the nose, it can also occur in the conchas of both cavities simultaneously.
Concha bullosa which usually has an asymptomatic and silent course, causes the middle concha to become bigger, thus causing the middle nasal passage and the air canals to the sinuses to occlude; hence, causes chronic sinusitis, pressure and pain on sinuses and eyes, chronic headaches; and rarely ear and jaw pains. The best diagnostic method is Computed Tomography.
Concha Bullosa can be categorized into three different types depending on their formation, namely Lamellar Concha Bullosa, Bulbous Concha Bullosa and Extensive Concha Bullosa.
Lamellar Concha Bullosa: The type of concha bullosa where the pneumatizations are seen in the vertical lamella (thin layer).
Bulbous Concha Bullosa: The type of concha bullosa where the pneumatizations are seen in the lower part of the middle concha which is known as the bulbous segment.
Extensive Concha Bulbosa: The type of concha bullosa where the pneumatizations are seen both in the vertical lamella of the concha and the lower segment of the middle concha. It is the most common type.
Concha Bullosa surgery is usually operated using one of the methods of breaking, concha shaping or concha resection/reduction.
The concha bullosa surgery method in which the doctor enters into the nose by means of a camera, and cuts and removes the part of the nose swollen like a balloon, which faces the opening of the sinuses, is called Endoscopic Concha Resection/Reduction.
Endoscopic concha resection/reduction is used when the bone structure is efficient in concha's growth and the desired result is not achieved through radio frequency application.
Endoscopic concha resection/reduction is an effective method for treating concha bullosa. Without causing too much bleeding and trauma, it allows for an easy access to osteomeatal complex which is the entrance region to the sinuses. Furthermore, by means of the minimal surgical intervention, since the mucous structure outside of the concha is not damaged, concha can fulfill its duty completely after the operation and no adhesion is seen in the interior of the nose.
Microdebrider device is commonly used. This device is only operated on the diseased part. While the diseased tissue is cleaned through filing or shaving, intervention site is synchronously washed and vacuum cleaned in order not to damage the healthy tissue around it. With this device of advanced technology, time and labour needs are diminished. The procedure is completed after a short period of 30 minutes. In addition, since the mucous membrane is not damaged, there is no need to use a tampon after the operation.
The patient is discharged on the same day of the surgery. But in order to prevent an increase in bleeding, for a period of 3-4 days, nose should be protected from excessive blowing and impacts that can cause trauma. Period of healing lasts approximately 6-8 weeks.
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