1308 - 4038 A case of middle turbinate absence

Introduction Middle nasal turbinate (concha) is one of three or four lateralto-medial extroflexions of the lateral nasal wall: they are the inferior turbinate, whose bony skeleton is an independent bone, and middle, superior and sometime supreme turbinates, whose bony structures are part of the ethmoid bone. Embryogenesis of the last three turbinates is a process induced by active intramural pneumatization of the lateral nasal wall during fetal life. Middle turbinate constitutes the superior and medial limits of middle nasal meatus, an air space in which maxillary sinus, anterior ethmoid cells, and frontal sinus drain mucus trough mucociliary clearance system. Anatomic variations of the middle turbinate or nearby structures are thought to have a causative role in acute and chronic rhinosinusitis and in their complications. In addition, the middle turbinate represents a crucial anatomical structure in endoscopic sinus surgery. In literature are described a case of defect of the septum and of the turbinate [1], a case of absence of both the conchae, the vomer, and the perpendicular plate [2], a case of rudimentary middle nasal concha [3], a case of bilateral hypoor a-genetic middle and inferior turbinates [4], and a case of unilateral agenesis of middle nasal turbinate [5]. Case Report During the educational year 2012-2013, within anatomical study of nose and paranasal sinuses in the Section of Anatomy and Physiopathology, Department of Clinical and Experimental Sciences, University of Brescia, Italy, we found this bilateral variation of the middle nasal turbinate (Figure 1). The middle turbinate wasn’t completely absent with the presence of the plate that is a common vertical component of both middle and superior turbinate; in addition, a prominence that could represent the rudimental posterior part of the partially absent turbinate, was found below the superior nasal meatus. The superior turbinate wasn’t well developed; it seemed to be mildly hypoplastic in its posterior aspects; the other structures of the lateral nasal wall (e.g. inferior turbinate, uncinate process, bulla ethmoidalis) appeared well developed (Figure 1). Vomer was normally developed, nevertheless, perpendicular plate of ethmoid bone was hypoplastic and there was a subcentimetral septal defect; no septal deviation or septal spur were present (Figure 2).