抵达鼻底的中鼻甲变异：双重病理生理学与描述性术语

文献信息

中文摘要

目的： Bolger分类法定义了三种泡状鼻甲类型，但未涵盖延伸至鼻底的极端中鼻甲变异。此前仅有一篇报告提供了定量测量值（45mm）。我们报告四例患者（垂直高度32-52mm），并区分原发性气化与继发性病变填充性膨大作为其潜在机制。
方法： 我们回顾性分析了2021年1月至2024年12月期间在一家三级鼻科中心接受内镜手术的患者。四例中鼻甲延伸至距鼻底≤3mm以内的患者接受了系统评估，包括高分辨率CT及标准化测量（垂直高度、宽度、距鼻底距离）、内镜检查、组织病理学分析以及手术治疗并随访一年。
结果： 四例患者均表现为中鼻甲巨大延伸并接触鼻底（垂直高度32-52mm）；三例患者（48-52mm）超出此前唯一量化的测量值（45mm）3-7mm（6.7-15.6%），而患者4（32mm）则符合距鼻底距离标准（≤3mm）。患者1和4表现为极端气化（含气泡状鼻甲，48mm和32mm），无鼻窦炎。患者2和3表现为继发性病理性膨大（变应性真菌性鼻窦炎50mm，黏液囊肿52mm），伴有鼻窦受累。两种机制最终汇聚于相似的解剖终点。所有患者均接受了内镜下减压，采用系统性的从前向后技术，并针对患者2和3添加了疾病特异性辅助操作（鼻窦清理、黏液囊肿引流、额窦开窗术），四例患者均获得极佳疗效。
结论： 抵达鼻底的中鼻甲变异是一种具有临床意义的模式，需要在影像学报告和手术规划中加以识别。由于两种机制具有相似的手术意义，因此宜采用描述性而非分类性术语。在正式分类之前，需要进行多中心验证并采用标准化测量。

英文摘要

PURPOSE: The Bolger classification defines three concha bullosa types but does not account for extreme middle turbinate variants extending to the nasal floor. Only one prior report provided quantitative measurements (45mm). We present four patients (32-52mm vertical height) and distinguish primary pneumatization from secondary disease-filled expansion as the underlying mechanisms.
METHODS: We retrospectively reviewed patients undergoing endoscopic surgery from January 2021 to December 2024 at a tertiary rhinology center. Four patients with middle turbinate extension to within ≤3mm of the nasal floor underwent systematic evaluation including high-resolution CT with standardized measurements (vertical height, width, floor distance), endoscopic examination, histopathological analysis, and surgical management with one-year follow-up.
RESULTS: Four patients demonstrated massive middle turbinate extension with floor contact (32-52mm vertical height); three patients (48-52mm) exceeded the only previously quantified measurement (45mm) by 3-7mm (6.7-15.6%), while Patient 4 (32mm) qualified by floor distance criterion (≤3mm). Patients 1 and 4 represented extreme pneumatization (air-filled concha bullosa, 48mm and 32mm) without sinusitis. Patients 2 and 3 demonstrated secondary pathological expansion (allergic fungal rhinosinusitis 50mm, mucocele 52mm) with sinus involvement. Both mechanisms converged on a similar anatomical endpoint. All patients underwent endoscopic decompression using a systematic anterior-to-posterior technique, with disease-specific adjuncts (sinus clearance, mucocele drainage, frontal sinusotomy) added for Patients 2 and 3, achieving excellent outcomes in all four.
CONCLUSION: Floor-Reaching Middle Turbinate Variants represent a clinically significant pattern requiring recognition in radiological reporting and surgical planning. Because both mechanisms carry similar surgical implications, descriptive rather than classificatory terminology is warranted. Multicenter validation with standardized measurements is needed before formal classification.