Variant anatomy of nasal turbinates: supreme, superior and middle conchae bullosae, paradoxical superior and inferior turbinates, and middle accessory turbinate.

Multiple anatomical variants were encountered during a cone beam computed tomography (CBCT) study of the nasal cavity of a 43-year-old male patient. These were mostly related to the nasal turbinates, suggestive for an unusual development of ethmoturbinals. Pneumatized turbinates were observed: bilateral supreme, superior, and middle concha bullosa. There were bilateral paradoxically curved superior turbinates, as well as a unilateral paradoxically curved inferior turbinate. There was also found a unilateral accessory middle turbinate, presenting as a medially bent uncinate process. Due to the presence of the Santorini's concha, the natural ostium of the sphenoidal sinus was medial to it, and was not directly related to the superior turbinate. Such variants, alone or in combination, should be documented prior to surgical procedures, endoscopic or microscopic, by rhinologists and neurosurgeons, prior to various sinonasal or skull base approaches. Patients should be evaluated on a case-by-case basis, as the Vesalian anatomy could not apply to all.