Crushing Versus Resection of Concha Bullosa as an Adjunct to FESS: Long-Term Randomized Controlled Trial.

Abstract

Concha bullosa (CB) is a common anatomical variation in patients with chronic and recurrent rhinosinusitis. Optimal surgical management of CB during functional endoscopic surgery (FESS) remains debated. This study compared crushing versus resection regarding symptom relief and endoscopic outcomes in 1-year follow-up. In this prospective randomized study, 62 patients undergoing FESS for chronic rhinosinusitis or recurrent acute rhinosinusitis had either CB crushing or resection as an adjunct procedure. The primary outcome was change in total SNOT-22 score at 1-year follow-up. Key secondary outcomes were endoscopic findings (synechiae severity and middle meatus access). Fifty-two patients (crushing, n = 30; resection, n = 22) completed 1-year follow-up. Both groups demonstrated improvement in SNOT-22 scores. However, improvement was significantly greater in the resection group (median difference 12.0 points, 95% CI 2.0-20.0; p = 0.032) reaching minimal clinically significant difference of 8.9 points. Rhinological and emotional subdomains showed greater improvement with resection. Synechia severity did not differ between groups (OR 1.00, 95% CI 0.38-2.60). Middle meatus access was significantly better after resection (OR 3.69, 95% CI 1.35-10.04; p = 0.009). Resection of concha bullosa during FESS was associated with greater symptom relief and quality of life improvement and better middle meatus access compared with crushing, without increased complications (trial registration: ClinicalTrials.gov, NCT06687629).