Tomblinson C M, Cheng M-R, Lal D, Hoxworth J M
From the Departments of Radiology (C.M.T., J.M.H.).
Biostatistics (M.-R.C.).
AJNR Am J Neuroradiol. 2016 Jul;37(7):1324-30. doi: 10.3174/ajnr.A4705. Epub 2016 Mar 3.
Inferior turbinate hypertrophy and concha bullosa often occur opposite the direction of nasal septal deviation. The objective of this retrospective study was to determine whether a concha bullosa impacts inferior turbinate hypertrophy in patients who have nasal septal deviation.
The electronic medical record was used to identify sinus CT scans exhibiting nasal septal deviation for 100 adult subjects without and 100 subjects with unilateral middle turbinate concha bullosa. Exclusion criteria included previous sinonasal surgery, tumor, sinusitis, septal perforation, and craniofacial trauma. Nasal septal deviation was characterized in the coronal plane by distance from the midline (severity) and height from the nasal floor. Measurement differences between sides for inferior turbinate width (overall and bone), medial mucosa, and distance to the lateral nasal wall were calculated as inferior turbinate hypertrophy indicators.
The cohorts with and without concha bullosa were similarly matched for age, sex, and nasal septal deviation severity, though nasal septal deviation height was greater in the cohort with concha bullosa than in the cohort without concha bullosa (19.1 ± 4.3 mm versus 13.5 ± 4.1 mm, P < .001). Compensatory inferior turbinate hypertrophy was significantly greater in the cohort without concha bullosa than in the cohort with it as measured by side-to-side differences in turbinate overall width, bone width, and distance to the lateral nasal wall (P < .01), but not the medial mucosa. Multiple linear regression analyses found nasal septal deviation severity and height to be significant predictors of inferior turbinate hypertrophy with positive and negative relationships, respectively (P < .001).
Inferior turbinate hypertrophy is directly proportional to nasal septal deviation severity and inversely proportional to nasal septal deviation height. The effect of a concha bullosa on inferior turbinate hypertrophy is primarily mediated through influence on septal morphology, because the nasal septal deviation apex tends to be positioned more superior from the nasal floor in these patients.
下鼻甲肥大和泡状鼻甲常出现在鼻中隔偏曲的对侧。本回顾性研究的目的是确定泡状鼻甲是否会影响鼻中隔偏曲患者的下鼻甲肥大。
利用电子病历识别100例无单侧中鼻甲泡状鼻甲的成年受试者和100例有单侧中鼻甲泡状鼻甲的成年受试者的鼻窦CT扫描图像，这些图像显示有鼻中隔偏曲。排除标准包括既往鼻窦手术史、肿瘤、鼻窦炎、鼻中隔穿孔和颅面外伤。在冠状面，鼻中隔偏曲的特征通过距中线的距离（严重程度）和距鼻底的高度来描述。计算下鼻甲宽度（整体和骨质）、内侧黏膜以及到鼻外侧壁距离的两侧测量差异，作为下鼻甲肥大指标。
有泡状鼻甲和无泡状鼻甲的队列在年龄、性别和鼻中隔偏曲严重程度方面匹配相似，不过有泡状鼻甲队列的鼻中隔偏曲高度大于无泡状鼻甲队列（19.1±4.3毫米对13.5±4.1毫米，P<.001）。通过下鼻甲整体宽度、骨质宽度和到鼻外侧壁距离的左右差异测量，无泡状鼻甲队列的代偿性下鼻甲肥大明显大于有泡状鼻甲队列（P<.01），但内侧黏膜情况并非如此。多元线性回归分析发现，鼻中隔偏曲严重程度和高度分别是下鼻甲肥大的显著预测因素，呈正相关和负相关（P<.001）。
下鼻甲肥大与鼻中隔偏曲严重程度成正比，与鼻中隔偏曲高度成反比。泡状鼻甲对下鼻甲肥大的影响主要通过对鼻中隔形态的影响来介导，因为这些患者的鼻中隔偏曲顶点往往位于距鼻底更高的位置。
