Morphological characteristics and clinical and surgical implications of the supreme nasal concha: an integrative review

Authors

DOI:

https://doi.org/10.33448/rsd-v11i10.33196

Keywords:

Anatomy; Nasal Cavity; Turbinates; Anatomic variation.

Abstract

Introduction: On the lateral wall of each nasal cavity, there are three conchas named according to their position: superior, middle and inferior. Eventually, there may be a fourth concha (of Santorini), known as the supreme concha. However, its specific characteristics are scarce in the literature, being superficially addressed in scientific studies and textbooks. Objective: To describe the morphological aspects of the supreme concha and analyze its clinical and surgical importance. Methodology: Integrative literature review with searches in PubMed, Scopus, Web of Science, Embase and MEDLINE databases. As a search tool, the descriptors “supreme concha nasal”, “supreme turbinate” and “concha Santorini” were used, as well as the Boolean operator “or”. Eligibility criteria consisted of original articles without language and publication period restrictions. Results and Discussion: Among 21 non-duplicated articles, six were selected. The supreme concha is found more bilaterally and its prevalence varies from 10% to 77% (average of 42.3%), being predominant in males and having a higher frequency in the second trimester of intrauterine life, in addition to having a similar size to the superior concha in most cases. The knowledge of the supreme concha is important for many endoscopic surgical procedures of the sinuses and skull base. Conclusion: The supreme concha is more common than previously thought. Imaging studies in computed tomography, mainly with 3D reconstruction, revealed a higher prevalence than anatomical studies in cadavers. It is inferred that the Santorini concha may not be an anatomical variation in some populations.

References

Abdullah, S. N. & Abdullah, B. (2020). Supreme Nasal Turbinate as an Additional Surgical Landmark in Endoscopic Sinus and Skull Base Surgeries. Cureus, 12(5), e8132.

Arreola, A. G. et al. (1996). Morphogenesis of the lateral nasal wall from 6 to 36 weeks. Otolaryngol. Head Neck Surg., 114(1), 54-60.

Bolger, W. E. (2001). Anatomy of the paranasal sinuses. In: Kennedy DW, Bolger WE, Zinreich SJ, eds. Disease of the Sinuses. B.C. Decker Inc., 1-12.

Bolger, W. E. et al. (1999). Use of the superior meatus and superior turbinate in the endoscopic approach to the sphenoid sinus. Otolaryngol. Head Neck Surg., 120(3), 308-313.

Christmas, D. A. et al. (2004). Supreme nasal turbinate as a landmark during endoscopic sphenoid sinus surgery. Ear Nose Throat, 83(2), 84-85.

Cobzeanu, M. D. et al. (2014). The anatomo-radiological study of unusual extrasinusal pneumatizations: superior and supreme turbinate, crista galli process, uncinate process. Rom. J. Morphol. Embryol., 55(1), 1099-1104.

Costa, A. V. R. (1999). Respiração bucal e postura corporal: uma relação de causa e efeito.

Escada, A. P. et al. (2009). The human olfactory mucosa. Eur. Arch. Otorhinolaryngol., 266, 1675-1680.

Felix, V. & Veerasigamani, N. (2017). Unilateral absence of ethmoid sinus and nasal turbinates: a rare case report. J. Clin. Diagn. Res., 11(4).

Gotlib, T. et al. (2018). The supreme turbinate and the drainage of the posterior ethmoids: a computed tomographic study. Folia Morphol., 77, 110-115.

Grazia K, J. A. et al. (2014). Prevalência de variantes anatômicas nasossinusais: Importância no laudo radiológico e na cirurgia endoscópica funcional. Revista Chilena de Radiología, 20(1), 5-12.

Hiatt, J. L. (2011). Anatomia: Cabeça & Pescoço (4a ed.). Guanabara Koogan.

Jafek, B. W. (1997). Olfactory mucosal biopsy and related histology. In: Seiden AM et al (eds) Taste and smell disorders. Thieme, New York, 107-127.

Kantarci, M. et al. (2004). Remarkable anatomic variations in paranasal sinus region and their clinical importance. Eur. J. Radiol., 50, 296-302.

Kim, H. U. et al. (2001). Surgical anatomy of the natural ostium of the sphenoid sinus. Laryngoscope, 114(1), 1599-1602.

Kim, K. S. et al. (2003). The risk of olfactory disturbance from conchal plate injury during ethmoidectomy. Am. J. Rhinol., 17(5), 307-310.

Kim, S. S. et al. (2001). Computed tomographic and anatomical analysis of the basal lamellas in the ethmoid sinus. Laryngoscope, 111(3), 424-429.

Koo, S. K. et al. (2018). A case of bilateral inferior concha bullosa connecting to maxillary sinus. Braz. J. Otorhinolaryngol., 84(4), 526-528.

Lang, J. (1989). Clinical anatomy of the nose, nasal cavity and paranasal sinuses. Thieme Medical, New York, 85-98.

Lang, J. & Sakals, E. (1982). Uber den Recessus sphenoethmoidalis, die Apertura nasalis des Ductus nasolacrimalis und den Hiatus semilunaris. Anat. Anz., 152, 393-412.

Levine, H. L. & Clemente, M. P. (2005). Surgical anatomy of the paranasal sinus. In: Levine HL, Clemente MP, eds. Sinus Surgery: Endoscopic and Microscopic Approaches. Thieme.

Măru, N. et al. (2015). Variant anatomy of nasal turbinates: supreme, superior and middle conchae bullosae, paradoxical superior and inferior turbinates, and middle accessory turbinate. Rom. J. Morphol. Embryol., 56(3), 1223-1226.

Mendes, K. D. L. et al. (2008). Revisão integrativa: método de pesquisa para a incorporação de evidências na saúde e na enfermagem. Texto & Contexto Enfermagem, Florianópolis, 17(4), 758-764.

Millar, D. A. & Orlandi, R. R. (2006). The sphenoid sinus natural ostium is consistently medial to the superior turbinate. Am. J. Rhinol., 20(2), 180-181.

Moore, K. L. et al. (2019). Anatomia orientada para a clínica (8a ed.). Guanabara Koogan.

Nieto, C. S. (2015). Tratado de otorrinolaringología y cirugía de cabeza y cuello (ebook online). Editorial Médica Panamericana, 450.

Orhan, M. et al. (2010). A surgical view of the superior nasal turbinate: anatomical study. Eur. Arch. Otorhinolaryngol., 267, 909-916.

Orlandi, R. R. et al. (1999), The forgotten turbinate: the role of the superior turbinate in endoscopic sinus surgery. Am. J. Rhinol., 13, 251-259.

Pati, D. & Lorusso, L. N. (2018). How to Write a Systematic Review of the Literature. HERD Health Environments Research & Design Journal, 11(1), 15-30.

Rossi, M. A. (2017). Anatomia craniofacial aplicada à odontologia: abordagem fundamental e clínica (2.ª ed.). Rio de Janeiro: Santos Ed.

Rusu, M. C. et al. (2019). The extremely rare concha of Zuckerkandl reviewed and reported. Rom. J. Morphol. Embryol., 60(3), 775-779.

Som, P. M. & Naidich, T. P. (2013). Illustrated review of the embryology and development of the facial region, part 1: Early face and lateral nasal cavities. AJNR Am. J. Neuroradiol., 34(12), 2233-2240.

Som, P. M. et al. (2003). Anatomy and physiology. In: Som PM, Curtin HD, editors. Head and neck imaging (4.ª ed.). St Louis: Mosby, 87-147.

Stammberger, H. (1991). Functional endoscopic sinus surgery. Mosby-Year Book: Philadelphia, 67-69.

Standring, S. (2010). Gray's Anatomia. (40.ª ed.). Rio de Janeiro: Elsevier.

Teixeira, L. M. S. et al. (2020). Anatomia Aplicada à Odontologia. (3.ª ed.). Rio de Janeiro: Guanabara Koogan.

Tortora, G. J. & Nielsen, M. T. (2019). Princípios de anatomia humana (14.ª ed.). Rio de Janeiro: Guanabara Koogan.

Yanagisawa, E. et al. (1998). Endoscopic localization of the sphenoid sinus ostium. Ear Nose Throat J., 77(2), 88-89.

Yilmaz, N. A. et al. (2010). Morphometric analyses of the development of nasal cavity in human fetuses: An anatomical and radiological study. International Journal of Pediatric Otorhinolaryngology, 74, 796-802.

Published

08/08/2022

How to Cite

SOARES, J. B.; PAIVA, M. D. E. B. Morphological characteristics and clinical and surgical implications of the supreme nasal concha: an integrative review. Research, Society and Development, [S. l.], v. 11, n. 10, p. e492111033196, 2022. DOI: 10.33448/rsd-v11i10.33196. Disponível em: https://rsdjournal.org/index.php/rsd/article/view/33196. Acesso em: 4 oct. 2022.

Issue

Section

Health Sciences