Rhinoplasty with Concha Bullosa Surgery Possible?

Question

I have had sinus issues in the past.  An MRI revealed a concha bullosa.   Do you think I need surgery for this?  I also have always wanted rhinoplasty.  Can I do the two surgeries together?

David C. Pearson, MD · Answer

First, the concha bullosa only requires treatment if it's causing or will likely cause nasal obstruction. Concerns about creating an overly dry nose are unfounded if the procedure is done correctly, which is to remove the lateral half of the concha bullosa and not to remove the entire middle turbinate.
This can certainly be treated at the same time as rhinoplasty, and it makes good sense to do so, if indicated (one anesthesia, one period of recovery, no effect on the aesthetic result, etc.)
All the best,
--DCP

William Portuese, MD · Answer

A concha bullosa is simply an ear pocket within the middle turbinate and is usually left alone unless it is full of polyps. There is no need to remove the concha bullosa. A rhinoplasty is done for aesthetic reasons. If the patient is going in for a rhinoplasty, the concha bullosa can be surgically opened quite easily, but patients do not need surgery just because they have a concha bullosa. Both surgeries can certainly be done together.

Tanveer Janjua, MD · Answer

Sinus surgery for concha bullosa and similar disorders can be done simultaneously with a Rhinoplasty.
The more important question is if sinus surgery is needed for the concha bullosa. It is indicated if you are having symptoms from it such as headaches, frequent sinus infections etc. Even in that situation a round of antibiotics is tried before making the decision to proceed with sinus surgery.
Regards

Ran Y. Rubinstein, MD · Answer

Lanafalana
Sinus surgery is performed if you have recurrent (4 or more infections per year) or chronic sinusitis (infection lasting more than 3 months which has failed to respond to antibiotics).  A concha bullosa is an enlarged turbinate, a structure near the sinus openings that can block them and lead to infections.  Most sinus problems are caused by allergies.  Treating these allergies effectively will often times prevent the need for sinus surgery in the future.
Rhinoplasty can be performed at the same time as sinus surgery, if indicated.  Make sure your plastic surgeon is both board certified in ear, nose & throat surgery (Otolaryngology) and plastic surgery if you are contemplating have both surgeries at the same time.
Good luck!

Michael A. Persky, MD · Answer

Hi Lana,
Yes, it is possible to have rhinoplasty surgery and removal of the concha bullosa during the same procedure. Have your surgeon make sure that there is not any purulent material (infection) in the conchas before your surgery.
The only reasons to operate on a concha bullosa are if they are causing recurrent infections, headaches, nasal obstruction, or if you want your insurance company to pay for the operating room, anesthesiologist, and a portion of your rhinoplasty surgeon's fee (just kidding about the last indication).
Good luck and be well.
Dr. P

Scott Trimas, MD · Answer

Sinus surgery can safely be done at the same time as a rhinoplasty and this includes a limited sinus surgery like removing concha bullosa that may be contributing to sinus issues. Some surgeons will even discount the cost of the cosmetic rhinoplasty when you have a functional surgery in conjunction with it. This is something that we and many other surgeons will commonly do so if you are thinking of having a rhinoplasty, you can usually save on the surgical fees as well as have one recovery session. As far as whether or not you need the concha bullosa treated typically depends on whether or not you are having symptoms of nasal obstruction, pressure or chronic sinusitis. I hope this information helps.

Steven J. Pearlman, MD, FACS · Answer

A concha bullosa is an air pocket in what is called the middle turbinate. This turbinate guards the opening into the sinuses. When it balloons out with a concha bullosa, it can cause recurrent sinusitis. If you have sinus symptoms it may need treatment. If it is an indecently finding on X-Ray it may not need treatment if its not symptomatic; discuss this with your doctor.
To answer the rest of your question, yes it can be treated at the same time as Rhinoplasty. This would be using a technique called endoscopic sinus surgery. Generally half the concha bullosa is removed so that when it heals it looks like a normal, thin middle turbinate. You don't want the entire concha removed; doing so could affect the normal airflow in your nose. Please make sure you see a specialist who is adept at both rhinoplasty as well as endoscopic sinus surgery if you are considering surgery for this condition.

Eric M. Joseph, MD · Answer

A concha bullosa is an air-filled space within your middle turbinate, and findings like this are routinely seen on MRIs and CT scans of your head. The concha bullosa may require surgery if it's blocking drainage of your sinuses, but that scenario is uncommon in my experience.
You should consult a board-certified ENT regarding your sinus issues. It would be helpful to bring a copy of your scans during that visit.
I hope this is helpful for you.
Best regards.

Otto Joseph Placik, MD · Answer

Yes, you can do the two operations together. However, treatment of the concha bullosa is only necessary if it is symptomatic.
Another question may be, will the rhinoplasty make the concha bullosa more symptomatic and that may be more difficult to predict. This depends on the agressiveness of the lateral osteotomies and limitation of the nasal valve. In some circumstances, you may require a secondary surgery to reduce it if necessary. Some physicians are reluctant to remove this at the first surgery due to the possibiliyty of complications or creating an overly dry nose.

Robert F. Gray, MD, FACS · Answer

Sure, it is safe to do simultaneous functional sinus/nasal surgery at the same time as cosmetic rhinoplasty. My question for you is why do you need to concha bullosa treated? Only do it if you are have some type of problem with the concha bullosa. Chronic facial pain, nasal obstruction, chronic sinusitis are some of the reasons to consider having the concha bullosa treated only after they have failed appropriate medical treatment.

	Good Luck!

Rhinoplasty with Concha Bullosa Surgery Possible?

Answers (15)

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