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Crushing Versus Resection of Concha Bullosa as an Adjunct to FESS: Long-Term Randomized Controlled Trial
Mario Järvekülg1, Paula Virkkula1, Johanna Wikstén1
1Department of Otorhinolaryngology, Head and Neck Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
The Laryngoscope
|July 31, 2026
Summary
Resecting a concha bullosa (CB) during functional endoscopic sinus surgery (FESS) significantly improves symptoms and quality of life compared to crushing. This CB resection technique also enhances middle meatus access without increasing complications.
Area of Science:
- Otolaryngology
- Rhinology
- Surgical Innovation
Background:
- Concha bullosa (CB) is a frequent anatomical variation linked to chronic rhinosinusitis.
- Surgical management of CB during functional endoscopic sinus surgery (FESS) is debated.
- This study evaluates CB crushing versus resection for symptom relief and endoscopic outcomes.
Purpose of the Study:
- To compare the efficacy of CB crushing versus resection as adjunct procedures during FESS.
- To assess symptom improvement using the SNOT-22 score at 1-year follow-up.
- To evaluate endoscopic outcomes, including synechiae severity and middle meatus access.
Main Methods:
- A prospective randomized study involving 62 patients with chronic or recurrent acute rhinosinusitis undergoing FESS.
- Patients were randomized to either CB crushing or resection.
- Primary outcome: change in SNOT-22 score; secondary outcomes: endoscopic findings.
Main Results:
- Fifty-two patients completed the 1-year follow-up.
- Both groups showed SNOT-22 score improvement, but resection yielded significantly greater improvement (p=0.032).
- Resection led to better rhinological and emotional subdomain scores, improved middle meatus access (p=0.009), and similar synechiae severity.
Conclusions:
- CB resection during FESS offers superior symptom relief and quality of life improvement compared to crushing.
- Resection also provides enhanced middle meatus access.
- No increased complications were observed with the resection technique.
