Giant Concha Bullosa Containing Ethmoid Bulla Inside: A Case Report

Paranasal sinus anatomy exhibits numerous variations, and preoperative awareness of these variations is essential for endoscopic sinus surgery. Concha bullosa, an air cell within the nasal turbinates, is most commonly seen in the middle turbinate, affecting 13 to 53.6% of patients. The ethmoid bulla, an air cell in the anterior ethmoid sinus, is anatomically close to the middle turbinate. We present a rare case of a giant concha bullosa containing an ethmoid bulla. A 52-year-old female presented with nasal obstruction and snoring. Examination revealed a slightly deviated septum and a giant concha bullosa in the left middle turbinate. CT scanning confirmed the concha bullosa with an ethmoid bulla inside, as well as a slightly deviated septum. Endoscopic surgery was performed to remove both the concha bullosa and ethmoid bulla. Postoperative recovery was successful, with resolution of her symptoms. Concha bullosa is classified into three types: bulbous, lamellar, and extensive, based on the extent of pneumatization. No classification currently describes a concha bullosa containing another nasal structure, such as an ethmoid bulla. Our case illustrates a unique variation. Paranasal sinus variations are common, and modern imaging allows for better preoperative planning. Recognizing both common and rare anatomical variations, such as the case presented, is crucial for safe and effective sinus surgery.