How many turbinates. turbinate surgery

Concha hypertrophy (J34.3) is a disease that is associated with the proliferation of tissues that form the nasal concha, resulting in impaired nasal breathing.

The weakest points, which are subject to greater stress, are the anterior ends of the middle shells and the rear ends of the lower shells. Under the influence of air jet blows, a compensatory increase in mucosal areas in “weak zones” occurs. Overgrowth of large sizes leads to a violation of nasal breathing. This process can be compared to the formation of calluses on the skin in places of friction.

chronic inflammation of the nasal mucosa (allergies, frequent acute respiratory viral infections, inhalation of volatile chemicals),
displaced nasal septum (increased aerodynamic load).

Clinical picture

Complaints about difficulty in nasal breathing one- or two-sided (permanent or intermittent); watery transparent selection from the nose.

Enlargement of the lower, middle turbinates.
The surface is smooth, bumpy or coarse-grained.
The mucous membrane is full-blooded, cyanotic or purple-bluish in color, covered with mucus.
Narrowing of the nasal passages.
Negative test with turbinate anemia.

Diagnosis of turbinate hypertrophy

Consultation with an otorhinolaryngologist.
Anterior rhinoscopy, endoscopy.
Rhinomanometry.

Differential Diagnosis:

Neoplasm of the nasal cavity.

Treatment of turbinate hypertrophy

Treatment is prescribed only after confirmation of the diagnosis by a specialist doctor. Surgical treatment in violation of the respiratory function (ultrasound of the lower turbinates, submucosal vasotomy).

Essential drugs

There are contraindications. Specialist consultation is required.

(local vasoconstrictor). Dosage regimen: intranasally, 0.05% solution of Nazivin, adults and children over 6 years old - 1-2 drops in each nasal passage 2-3 times a day. The drug should be used no more than 3-5 days.
(topical glucocorticosteroid). Dosage regimen: intranasally, adults and children over 12 years old, 2 doses (100 mcg) in each nasal passage 1 time per day, preferably in the morning. The maximum dose should not exceed 400 mcg / day. (4 doses in each nasal passage).
Terfenadine (H1 antihistamine). Dosage regimen: inside, adults and children over 12 years old, 60 mg 2 times / day. or 120 mg 1 time / day.

Inferior turbinate is an independent bone (os turbiuale), while the rest of the shells are plates extending from medial wall lattice labyrinth.

Inferior turbinate in the middle part of its upper edge forms the lower edge of the hiatus maxillaris; the anterior and posterior ends of its upper edge are attached, respectively, to the frontal process and the vertical plate of the palatine bone. In both places of attachment of the shell, the anterior (lacrimal) and posterior (ethmoid) processes extend upward, and from its upper edge - the maxillary process, narrowing the hiatus maxillaris.

Line attachments the lower shell stretches backwards, arcuate upwards, which should be taken into account when conchotomy. Very rarely there is a bifurcation of the anterior end of the lower shell.

Middle turbinate the anterior end (protruding 1-2 cm anterior to her body) is attached to the frontal process, and the posterior end to the palatine bone immediately under the pterygopalatine foramen. The most important practically anatomical variants of the shell are as follows. Sometimes this bony bladder is so significant that it simultaneously pushes back the nasal septum and the lateral wall of the nasal cavity, protruding the latter into the maxillary sinus, and closes the holes leading to the maxillary and frontal sinuses, while it protrudes anteriorly, hanging over the inferior nasal concha, on the threshold of the nasal cavity. cavities.
Superior turbinate shorter and narrower than the rest and has a common anterior end with the middle shell. Sometimes it is rudimentary and may be absent.

According to the three shells in the nasal cavity, there are three nasal passages.
inferior nasal passage has a length of 12 to 24 mm. Above, the lacrimal canal passes into the lacrimal fossa, in which the lacrimal sac is located. The lateral wall of the lower nasal passage, unlike the upper one, is entirely bony; at the place of its departure from the bottom of the nasal cavity, it is rather thick, and gradually becomes thinner upwards, especially in the area of attachment of the inferior turbinate.

The thinnest point corresponds maxillary process of the concha. Therefore, the puncture of the maxillary sinus should be performed as close as possible to the place of attachment of the shell, 2 cm away from its front end. The width of the lower nasal passage depends on the angle of the concha from the lateral wall of the nose and on the position of this wall, the degree of its protrusion towards the maxillary sinus or, conversely, towards the inferior nasal passage.

middle nasal passage limited by the free edges of the lower and middle turbinates. The lateral wall of the middle course is not bony throughout. Hiatus maxillaris is covered on the macerated skull by a number of bone formations (the maxillary and ethmoid processes of the lower shell, the uncinate process of the ethmoid bone), however, a significant part of the opening remains, which is tightened under natural conditions soft tissues, the so-called fountains.

These fontanelles(fontanelles) are a duplication of the mucous membrane (fused sheets of the mucous membrane of the nasal cavity and maxillary sinus). Most often there are anterior and posterior fontanelles, separated by a ethmoid process of the lower shell, and in the absence of the latter, one continuous fontanel. Sinus puncture through the middle course is usually performed through the back fountain. After removal anterior section the middle shell on the lateral wall has a crescent-shaped slit hiatus semilunaris (H. I. Pirogov, who first described this slit, called it semicanalis obliquus).

This semi-channel in the posterior superior section it is limited by the bulla ethmoidalis (also first described by N.I. Pirogov), a protrusion of the ethmoid labyrinth, and in the anterior inferior by the uncinate process (processus uncinatus), extending from the anterior edge of the middle turbinate.

To make a diagnosis, it is necessary to know how the structures of the nose communicate with the surrounding space. The anatomy of the structure helps specialists assess the severity of the disease.

The turbinates adjoin the lateral wall. Between them is a free space, which is called the nasal passage.

The superior turbinate is part of the ethmoid labyrinth. The nasal plates in adults and children have the same structure. They consist of a bone base, which is covered with a mucous membrane on top. Mucus prevents inflammation that can occur in the nasal cavity.

This body contains:

cells with cilia that protect mucous membranes from pathogenic microorganisms.
goblet cells produce mucus necessary for constant cleansing of harmful components.

bottom sink

The inferior turbinates resemble small curved plates.

They are an independent bone and are located next to the sky. The lower end of this organ is free. Below it is the lower nasal passage, which has a slit-like structure.

The lower part of the ethmoid bone is considered the largest area in.

She is responsible for the correct distribution of air flow.

Epithelial cells purify the incoming air from various impurities.

The mucosa acts as the first line of defense that protects the nasopharynx from pathogens. This place is concentrated a large number of immunocompetent cells.

When a person becomes infected, an inflammatory process begins. In this way, the body tries to cope with harmful bacteria. The mucosa covering the lower plate contains blood vessels that can dilate in response to various factors.

Allergen exposure can lead to. A negative reaction may be associated with a change in the temperature of the air entering the nasal passages.

Unlike adult patients, the nasal passages in children are too narrow. They have not yet formed bones. The inferior concha may descend to the bottom of the nasal cavity. Such a defect leads to respiratory failure.

How is the middle nasal concha arranged?

The main purpose of this organ is the redistribution of air entering the nose during inhalation. The middle turbinate consists of 2 parts.

Due to the curved shape of the plate, they cover the olfactory gap. In this way, it protects the receptors from harmful impurities. The middle shell adjoins the process of the frontal bone and the palate.

The unique structure of the turbinates serves to direct the incoming oxygen to the nasopharynx. In the lateral wall, you can see a special bend that contributes to the development of rhinitis.

There may be a doubled end at the front of the shell. You can assess its condition during the conduct.

Functions of the nasal cavities

The conchas of the nose are paired bones that are designed to ensure proper breathing. When exhaling, the middle nasal plate rises.

Thanks to this mechanism, the passage to the olfactory receptors is closed. This is necessary to prevent the entry of harmful impurities contained in the exhaust air to the nasopharynx.

Mucus is necessary to trap microscopic dust particles that are present in the air. In the process of oscillation of the cilia, mucus is removed along with harmful bacteria and dust.

The turbinates have vertical plates located on both sides. The air inhaled by a person passes through the nasal passages. They are located between the shells. In the lower bone there is a special opening that connects to the lacrimal canals. It is in this place that their contents accumulate.

This structure of the plates serves to increase the area of the nasal cavity. This helps the body to warm the incoming air faster. Cavernous bodies are located in the bone tissues of the nasal plates.

In case of blood retention, the lower shells swell in a person. This increases the resistance to airflow, which can lead to complete blockage of the nasal passages. The blood filling of the cavernous bodies is influenced by several factors:

the amount of dust in the air;
the development of inflammatory processes in the sinuses;
air temperature.

The superior nasal passage is behind and has openings that lead directly to the sinuses. Protecting the sinuses would be impossible without the mucous membrane. She is directly involved in the process of moisturizing the nasopharynx.

The secreted mucus has bactericidal properties. It destroys pathogenic microorganisms. The nasal cavities perform a resonator function. The timbre of a person's voice depends on their condition.

The inside of the nose contains a layer of epithelium that contains receptor cells. Thanks to these cells, a person can recognize various odors.

Which of the turbinates is an independent bone? To do this, you need to understand the anatomical structure of the nasal cavities. Thanks to the visual representation of this organ in the photo, it can be understood that only the lower shell can be considered a full-fledged bone.

Conclusion

The nasal cavity is divided into 3 types of shells: upper, middle and lower. Knowledge of anatomy helps doctors make the correct diagnosis. Only the inferior nasal concha is considered an independent bone.

Inhaled air passes between them, which is cleaned of various contaminants. From above, the plates are covered with a layer of epithelium, which protects the nasopharynx from viruses and bacteria.

The lower section of the medial wall of the labyrinth, located in the nasal cavity between the superior and inferior turbinates.

1. Small medical encyclopedia. - M.: Medical Encyclopedia. 1991-96 2. First health care. - M.: Great Russian Encyclopedia. 1994 3. Encyclopedic Dictionary medical terms. - M.: Soviet Encyclopedia. - 1982-1984.

See what "Concha average" is in other dictionaries:

- (concha nasalis media, PNA, BNA, JNA) a thin curved plate of the ethmoid bone extending from the lower part of the medial wall of the labyrinth, located in the nasal cavity between the upper and lower nasal conchas ... Big Medical Dictionary

TURBINATE- (nasal concha) any of the three thin curved plates protruding on the lateral wall of the nasal cavity. The upper (superior) and middle (middle nasal conchae) shells are processes of the ethmoid labyrinth of the bone of the same name; lower nasal ... ... Dictionary in medicine

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Digestive system- ensures the absorption by the body of the nutrients it needs as a source of energy, as well as for cell renewal and growth of nutrients. The human digestive system is represented by the digestive tube, large glands of the digestive ... ... Atlas of human anatomy

Lateral wall of the nasal cavity- frontal bone (scales of the frontal bone); frontal sinus; cockscomb; ethmoid plate of the ethmoid bone; superior turbinate; middle turbinate; sphenoid sinus; sphenopalatine opening; inferior turbinate; vertical … Atlas of human anatomy

The cavity of the pharynx (cavum pharyngis) on the sagittal section- tubal-palatine fold; pharyngeal opening of the auditory tube; pharyngeal tonsil; pharyngeal pocket; pipe roller; anterior arch of atlas; soft sky; tubal pharyngeal fold; uvula of the soft palate; palatoglossal arch; palatine tonsil; palatine... ... Atlas of human anatomy

Bones of the brain skull- The occipital bone (os occipitale) (Fig. 59A, 59B) is unpaired, located in the posterior part of the brain skull and consists of four parts, located around the large opening (foramen magnum) (Fig. 60, 61, 62) in the anteroinferior section of the outer ... … Atlas of human anatomy

Respiratory system- The respiratory organs provide gas exchange, saturating the tissues of the human body with oxygen and releasing them from carbon dioxide, and also take part in the sense of smell, voice formation, water-salt and lipid metabolism, and the production of certain hormones. AT… … Atlas of human anatomy

NOSE- NOSE. Contents: I. Comparative anatomy and embryology. . 577 II. Anatomy...................581 III. Physiology...................590 IV. Pathology .................... 591 V. General operative surgery of the nose ..... 609 D. Comparative anatomy and ... ... Big Medical Encyclopedia

Ethmoid bone- Ethmoid bone, os ethmoidale, unpaired. Most of it lies in the upper parts of the nasal cavity, the smaller part in the anterior parts of the base of the skull. It has the shape of an irregular cube, consists of air cells and belongs to the group ... ... Atlas of human anatomy

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What does inferior turbinate hypertrophy mean? To understand this issue, let's start with what they themselves are. In total there are three pairs: lower, middle and upper. They are bony outgrowths and are located on the lateral wall of the nasal cavity. Sinks are designed to direct and regulate the flow of air in the nasal passages. In this case, the mucous membrane should be healthy and well developed. The main role in this process belongs to the lower shells.

Under the influence of various ailments, including manifestations of an allergic nature and diseases of a viral etiology, deformation processes can begin to develop, resulting in the formation of asymmetry of the nasal shells and mucous membranes. This anomaly can also develop after injury and mechanical damage. In medical terminology, the disease is called hypertrophy or conchobulosis of the nasal concha. In this article, we will consider in detail the causes, signs and methods of treating turbinate hypertrophy.

Nasal concha hypertrophy- This is a pathological process, accompanied by a gradual growth and thickening of the nasal mucosa. As a result, the patient has respiratory failure.

Deformation changes are accompanied by accelerated release of secretory fluid and mucus. With hypertrophy of the nasal mucosa the inner surface becomes bumpy and loses uniformity.

Among the main causes of hypertrophy of the nasal concha are:

Allergic rhinitis. The most common cause development of conchobulosis of the nasal concha. The inflammatory reaction resulting from the action of allergens on the nasal membrane leads to the appearance of edema. The result is temporary hypertrophy.
Chronization inflammatory process , leading to asymmetry of the nasal passages, provokes a violation of the passage of air. As a result, pressure on the nasal mucosa increases, which leads to the growth of epithelial tissue.
Deviation of the nasal septum. The deformation of the plate prevents the passage of air in one section of the nose and creates an increased load on its second section. Violation of the structure of the respiratory organ leads to heterogeneous growth and thickening of the mucosa. Over time, breathing in such patients becomes significantly more difficult.

Often, turbinate hypertrophy is the result of prolonged use of vasoconstrictor drugs not prescribed by a doctor.

In addition to the above reasons, the occurrence of hypertrophy can be due to poor human health and a number of external negative factors, among which are:

smoking;
harmful working conditions;
the effect of hormonal agents.

Types of hypertrophy

The most vulnerable areas for the development of conchobulosis are the posterior part of the lower shell and the anterior end of the middle one. This is due to the features anatomical structure nasal passages that allow air to pass through. It is in these places that hypertrophic processes are most often observed.

At the moment, there are 2 types of pathology of the turbinates:

Hypertrophy of the posterior ends of the inferior turbinates most often develops against the background of chronic rhinitis. During the examination, the presence is noted, which can block the lumen in the inside of the nose. In this scenario, bilateral development of hypertrophy occurs. Pathology is characterized by a lack of symmetry.
Conchobulosis of the anterior ends of the middle turbinates- the most rare pathology. The disease occurs against the background of the development of the inflammatory process in.

Signs and diagnosis of pathology

Treatment of turbinate hypertrophy is carried out only after quality diagnostics. Questioning and examining patients is also important.

Expressed manifestations indicating the development pathological changes, are:

difficulty breathing through the nose, which can be observed both during inhalations and exhalations;
the appearance of nasality in the voice;
feeling foreign body in ;
headache;
profuse mucous discharge from the sinuses;
tinnitus;
decrease in olfactory sensations.

Symptoms of turbinate hypertrophy are very similar to manifestations.

In addition to the analysis of the main symptoms, before making a diagnosis, rhinoscopy. Examination reveals the degree of hypertrophy of the turbinates and changes in the mucous membrane. In the photo below you can see a rhinoscopy picture of a patient with hypertrophy of the inferior turbinates.

Treatment of turbinate hypertrophy

Elimination of turbinate hypertrophy is a matter exclusively for specialists. Treatment should be prescribed only by a doctor based on the results of the study, causal factors and general condition patient.

It is worth noting that drug therapy most of the time it turns out to be powerless. Drug treatment, although it helps to cope with the symptoms of hypertrophy, has little effect on the underlying cause. That is why pathology is treated mainly by surgery.

There are several methods of surgical intervention:

Conchotomy. consists in removing the overgrown portion of the mucous membrane from the nasal passage. Partial removal shells in the nose occurs through the use of a wire loop. The excess overgrown tissue is excised, excluding the bones.
Galvanocaustic method, based on input in nasal cavity heated electrode, which is held along the mucosa. The essence of the process is that the mucosa first grows even more, after which the damaged tissue dies. After healing, a scar forms in the nasal cavity, which is subsequently rejected. If the operation was successful, then nasal breathing is restored.
Nasal plate resection, which is carried out if it is necessary to eliminate bone or cartilage tissue.
Septoplasty- surgical correction of the nasal septum in order to eliminate its curvature.
Elimination of hypertrophy by using high-frequency ultrasound. With the help of this manipulation, excess tricky tissue is removed. Before the procedure, an endoscopic and x-ray examination is mandatory. This operation is bloodless, which excludes damage to the mucosa and the formation of crusts. After ultrasound treatment, swelling decreases, and the respiratory process is restored.

In the case of a successful operation, the patient's breathing is restored, and a properly selected drug treatment during the rehabilitation period prevents the development of complications. In most cases, turbinate hypertrophy is temporary and reversible.

Concerning folk methods treatment, they can only be used as additional measures. It is not recommended to carry out such therapy on your own without consulting a specialist.