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Nasal Concha Explained
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Overview
The nose is the respiratory and olfactory organ of the body. The nasal cavity consists of several compartments and structures such as conchae, meatuses, cribriform plates, and many more.
Nasal turbinates or nasal conchae are the narrow, long, and curled bones which protrude inside the nasal cavity. These bony projections run towards the midline and downwards in the nasal cavity. All types of conchae help in dividing the nasal cavity into groove-like air passages that are essential for nasal breathing. In addition, these bones help provide significant landmarks for the surgical procedures that involve accessing the skull through the nose.
Structure
Nasal conchae divide into three parts:
- Superior nasal concha – This is the uppermost nasal concha. In terms of size, it is the smallest concha in the body. The superior concha serves the role of protecting the olfactory bulb which is important in the sensation of smell.
- Middle nasal concha – It is usually the size of the fifth finger. This concha connects directly to the ethmoid and maxillary sinuses. It acts as a buffer for the protection of sinuses from the increased pressure in nasal airflow.
- Inferior nasal concha – Of all the conchae, the inferior concha is the largest one which may equal the size of the index finger. Inferior conchae are responsible for giving airflow direction, filtration, heating, and humidification of the air entering the nasal cavity.
Meatuses
Meatuses are the passages that lie underneath each conchae. Each of these meatuses is capable of communicating with the nasal cavity independently
Meatuses are divided into 3 types:
Inferior meatus
It lies under the surface of the inferior concha, and of all the three meatuses, the inferior concha is the largest. A duct that drains tears from the eyes, known as the Nasolacrimal duct, connects to the inferior meatus and drains into the nasal cavity.
Middle meatus
It lies just below the middle concha. The middle meatus is connected to multiple air sinuses on the face.
Superior meatus
It lies just below the superior concha. Of all the meatuses, superior meatus is the shallowest and shortest meatus in size. This is because the superior meatus receives openings from the ethmoidal sinuses.
Nerve Supply
The four quadrants of the nasal conchae are supplied by sensory nerve branches of the trigeminal nerve
Olfactory or special sensory nerves have distributions to the superior concha to aid in the sense of smell.
Blood supply
The nasal cavity and surrounding structures have a rich supply of blood. Both the external and internal carotid arteries give blood supply to the nose.
Ethmoidal arteries are the ophthalmic artery branches that descend into the cavity of the nose via the cribriform plate to supply the nasal concha.
The facial artery also gives blood supply to parts of the conchae. A few branches of the sphenopalatine artery also supply the concha.
Venous drainage
The nasal conchae form a venous plexus that drain to the facial, and pharyngeal veins.
Lymphatic drainage for nasal conchae
For lymphatic drainage, lymph from the nasal conchae drains into the submandibular, deep cervical, and retropharyngeal nodes.
Functions of the nasal conchae
There are a few basic functions of the nasal conchae:
- They are responsible for airflow direction, filtration, heating, and humidification of the air entering the nasal cavity.
- They protect the olfactory bulb which is important in the sensation of smell.
- They act as buffers for the protection of sinuses from the increased pressure in nasal airflow.
Associated Diseases
Infection
Invasion of the nasal cavity or concha by microorganisms causes infection of the nasal cavity This can be acute, chronic, or recurrent acute depending on the duration. Infection can lead to abscess formation. Most nasal cavity infections are viral, and only a small proportion develops due to bacteria. Rhinoviruses, influenza viruses, and parainfluenza viruses are the most common causes of sinusitis (inflammation of the sinuses).
Acute invasive fungal sinusitis is the infection of sinuses by fungi. This type of infection is common in people having immunocompromising conditions like HIV, Organ transplant patients, and Diabetes. The responsible pathogens for this infection are Absidia, Rhizopus, and Aspergillus.
JNA (Juvenile Nasopharyngeal Angiofibroma)
JNA is a vascular mass commonly found in the nasal cavity of adolescent males. These growths are not cancerous but can damage nerves and bones in the nasal cavity. They can also block the ear and sinus drainage. The commonest causes of the JNA are nasal obstruction and recurrent nasal bleeding. The mainstay of treatment for juvenile nasal angiofibroma is surgery to remove the tumor.
Allergic rhinitis
This is the inflammation of the nasal cavity structures. It causes nasal blockage, frequent sneezing, and excessive water-like discharge from the nose. These symptoms happen when the person breathes in something they are allergic to, such as dust, animal dander, or pollen.
The most common characteristic of this condition is the hypertrophy (increase in size) of the inferior conchae causing nasal obstruction and difficulty in breathing.
Fractures
Fractures of the nasal bone are commonly due to physical or mechanical trauma. Fracture of the nasal bone can lead to profuse bleeding and obstruction in the nasal cavity. Fractures associated with the nasal cavity are treated by Ear, Nose and Throat surgeons.
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