OtoRhinoLaryngology Portal

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The Nasal Turbinates As Seen On Endoscopic Examination

The Middle Meatus: Intraoperative View after Decongestion

S- nasal septum, MT- middle turbinate, B/BE- bulla ethmoidalis,

stars- uncinate process.

 

Video of left middle meatus without prior decongestion.

Primary Sinus Ostium

The primary ostium of maxillary sinus is located behind the uncinate process.

 

 

Natural sphenoid sinus ostium as seen from left nasal cavity (arrow). (Dashed line - sphenoethmoid recess, red arrow - direction towards nasopharynx)

Accessory Maxillary Ostium

 Ostium (slit-like)                                 Ostium (elliptical)

 Accessory sinus ostia (arrows). (MT - middle turbinate, S - septum)

                                                     Ostia (multiple)

 

The secondary ostium of maxillary sinus is located anterior

to the uncinate process and can be multiple.

 Natural maxillary sinus ostium (white arrow) versus accessory sinus ostium (red arrow).  White line - uncinate process, S - nasal septum (deviated).  This may contribute to the phenomena of recirculation and predisposes to sinusitis.

Uncinate Process:  Endoscopic Appearance of Anatomical Variations

 

The concealed type.

A straight forward easy to see uncinate process.

Medialized right uncinate process.

 

Elevated/off-ground left uncinate process.

 Broad-based uncinate process attachment superiorly

with a paradoxically curved right middle turbinate.

Pneumatized uncinate process attachment (circle).

 

Medialized and almost fully pneumatized uncinate process.

 

Medialized and pneumatized uncinate process.

Confluence of agger nasii cells

and pneumatized cum separated uncinate process.

"Stand alone" and pneumatized uncinate process.

"Obstructive" uncinate process.

 Polypoid and medialized uncinate process (UP).  [MT - middle turbinate, S - nasal septum, ANC - pneumatized agger nasii, arrow - septal spur]

S - nasal septum, MT - middle turbinate, UP - uncinate process

 

Watch video of uncinate process @ YouTube

Bulla Ethmoidalis

Variant of bulla ethmoidalis.

 

Compare with normal as describe under [The Middle Meatus:

Intraoperative View after Decongestion] section above.

Agger Nasii Cell

 

Pneumatized agger nasii (yellow cicle)

 Agger nasii area (red circle)

 

Prominence just anterior to the middle turbinate attachment (circles).

Conchal Bullosa (Pneumatized) Middle Turbinate Bone

                 Globular-shaped                              Diffused banana-shaped

 Inferiorly-placed ostea of concha (arrow)  Laterally-placed ostea of concha (arrow)

 

  Small slit-like opening of conchal bullosa.       Double lateral opening of concha

                       (arrow).                                                      (arrows)

                                                                   S - septum, MT - middle turbinate

 

S - septum, MT - middle turbinate

 

Intra-operative close-up view of left concha bullosa.

 

Another close-up view of CT-scan proven left middle turbinate concha bullosa. 

 

Watch video of conchal bullosa ostium/ostea at YouTube

Video 1                                   Video 2

 

 

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