Nasal concha

In anatomy, a nasal concha (/ˈkɒnkə/), plural conchae (/ˈkɒnki/), also called

Nasal concha
a turbinate or turbinal, is a long, narrow, curled shelf of bone that protrudes
into the breathing passage of the nose in humans and various animals. The
conchae are shaped like an elongated seashell, which gave them their name
(Latin concha from Greek κόγχη). A concha is any of the scrolled spongy
bones of the nasal passages in vertebrates.[1]

In humans, the conchae divide the nasal airway into 4 groove-like air
passages, and are responsible for forcing inhaled air to flow in a steady,
regular pattern around the largest possible surface area of nasal mucosa. As a
ciliated mucous membrane with shallow blood supply, the nasal mucosa
cleans and warms the inhaled air in preparation for thelungs.

A rapidly dilating arteriolar circulation to these bones may lead to a sharp Lateral wall of nasal cavity, showing
increase in the pressure within, in response to acute cooling of the body core. ethmoid bone in position. (Superior and
The pain from this pressure is often referred to as "brain freeze", and is middle in pink, and inferior in blue.)
frequently associated with the rapid consumption of ice cream. The
shallowness of the venous blood supply of the mucosa contributes to the ease
with which nosebleed can occur.

Contents
Structure
Details
Function
Immunological role Identifiers
Smell Latin conchae nasales
Clinical significance MeSH D014420
Dysfunction
Surgery FMA 57456

Other animals Anatomical terms of bone

See also
Additional images
Notes
References

Structure
Conchae are composed of pseudostratified columnar, ciliated respiratory epithelium
with a thick, vascular, and erectile glandular tissue layer.[2] The conchae are located
laterally in the nasal cavities, curling medially and downward into the nasal airway. Illustration of Upper Respiratory
Each pair is composed of one concha in either side of the nasal cavity
, divided by the System
septum.[2]
The superior conchae are smaller structures, connected to the middle conchae by nerve-endings, and serve to protect the olfactory
[1]
bulb. The openings to the posterior ethmoidal sinuses exist under the superior meatus.

The middle conchae are smaller. In humans, they are usually as long as the little finger. They project downwards over the openings of
the maxillary and anterior and middle ethmoid sinuses, and act as buffers to protect the sinuses from coming in direct contact with
[1]
pressurized nasal airflow. Most inhaled airflow travels between the inferior concha and the middle meatus.

The inferior conchae are the largest, and can be as long as the index finger in humans, and are responsible for the majority of airflow
[1]
direction, humidification, heating, and filtering of air inhaled through the nose.

The inferior conchae are graded 1-4 based on the inferior concha classification system (known as the inferior turbinate classification
system) in which the total amount of the airway space that the inferior concha takes up is estimated. Grade 1 is 0-25% of the airway,
.[3]
grade 2 is 26-50% of the airway, grade 3 is 51-75% of the airway and grade 4 is 76-100% of the airway

There is sometimes a pair of supreme conchae superior to the superior conchae. When present, these usually take the form of a small
crest.

Function
The conchae comprise most of the mucosal tissue of the nose and are required for functional respiration. They are enriched with
airflow pressure and temperature-sensing nerve receptors (linked to the trigeminal nerve route, the fifth cranial nerve), allowing for
tremendous erectile capabilities of nasal congestion and decongestion, in response to the weather conditions and changing needs of
the body.[2] In addition, the erectile tissue undergoes an often unnoticed cycle of partial congestion and decongestion called the nasal
cycle. The flow of blood to the nasal mucosa in particular the venous plexus of the conchae is regulated by the pterygopalatine
ganglion and heats or cools the air in the nose.

The nasopulmonary and nasothoracic reflexes regulate the mechanism of breathing through deepening the inhale. Triggered by the
flow of the air, the pressure of the air in the nose, and the quality of the air, impulses from the nasal mucosa are transmitted by the
trigeminal nerve to the breathing centres in the brainstem, and the generated response is transmitted to the bronchi, the intercostal
muscles, and the diaphragm.

The conchae are also responsible forfiltration, heating, and humidification of air inhaled through the nose. Of these three, filtration is
achieved mostly by other more effective means such as mucous and cilia. As air passes over the conchae, it is heated to 32 - 34 °C
(89 - 93 °F), humidified (up to 98%water saturation) and filtered.[2]

Immunological role
The respiratory epithelium that covers the erectile tissue (or lamina propria) of the conchae plays a major role in the body's first line
of immunological defense. The respiratory epithelium is partially composed of mucus-producing goblet cells. This secreted mucus
covers the nasal cavities, and serves as a filter, by trapping air-borne particles larger than 2 to 3 micrometers. The respiratory
epithelium also serves as a means of access for the lymphatic system, which protects the body from being infected by viruses or
bacteria.[1]

Smell
The conchae provide, first and foremost, the humidity needed to preserve the delicate olfactory epithelium, which in turn is needed to
keep the olfactory receptors healthy and alert. If the epithelial layer gets dry or irritated, it may cease to function. This is usually a
temporary condition but, over time, may lead to chronic anosmia.[2] The turbinates also increase the surface area of the inside of the
nose, and, by directing and deflecting airflow across the maximum mucosal surface of the inner nose, they are able to propel the
inspired air. This, coupled with the humidity and filtration provided by the conchae, helps to carry more scent molecules towards the
[1]
higher, and very narrow regions of the nasal airways, where olfaction nerve receptors are located.
The superior conchae completely cover and protect the nerve axons piercing through the cribriform plate (a porous bone plate that
separates the nose from the brain) into the nose. Some areas of the middle conchae are also innervated by the olfactory bulb. All three
pairs of conchae are innervated by pain and temperature receptors, via the trigeminal nerve (or, the fifth cranial nerve).[2] Research
has shown that there is a strong connection between these nerve endings and activation of the olfactory receptors, but science has yet
to fully explain this interaction.

Clinical significance

Dysfunction
Large, swollen conchae, often referred to clinically as turbinates, may lead to blockage of nasal breathing. Allergies, exposure to
environmental irritants, or a persistent inflammation within the sinuses can lead to turbinate swelling. Deformity of the nasal septum
can also result in enlarged turbinates.[4]

Treatment of the underlying allergy or irritant may reduce turbinate swelling. In cases that do not resolve, or for treatment of deviated
septum, turbinate surgery may be required.

Surgery
There are different forms of turbinate surgery: Somnoplasty - bipolar radiofrequency ablation - a technique used for coblation
tonsillectomy, is also used for the treatment of swollen turbinates; reduction by the use of pure heat can be equally effective as can
turbinate sectioning. In the case of sectioning, because the turbinates are essential for respiration, only small amounts of turbinate
tissue should be removed. Risks of turbinate surgery, including reduction of the inferior or middle turbinates, include empty nose
syndrome.[4] Dr. Houser: "this is especially true in cases of anterior inferior turbinate (IT) resection because of its important role in
the internal nasal valve."[5]

Concha bullosa is an abnormal pneumatization of the middle turbinate, which may interfere with normal ventilation of the sinus ostia
and can result in recurrentsinusitis.

Other animals
Generally, in animals, nasal conchae are convoluted structures of thin
bone or cartilage located in the nasal cavity. These are lined with
mucous membranes that can perform two functions. They can
improve the sense of smell by increasing the area available to absorb
airborne chemicals, and they can warm and moisten inhaled air, and
extract heat and moisture from exhaled air to prevent desiccation of The horse breathes through nares (nostrils) which
the lungs. Olfactory turbinates are found in all living tetrapods, and expand during exercise. The nasal passages have
respiratory turbinates are found in most mammals and birds. two turbinates on either side which increase the
surface area to which air is exposed.
Animals with respiratory turbinates can breathe faster without drying 1 : Concha nasalis dorsalis
out their lungs, and consequently can have a faster metabolism.[6] 2 : Concha nasalis media
For example, when the emu exhales, its nasal turbinates condense 3 : Concha nasalis ventralis
moisture from the air and absorbs it for reuse.[7] Dogs and other
canids possess well-developed nasal turbinates.[8] These turbinates
allow for heat exchange between small arteries and veins on theirmaxilloturbinate (turbinates positioned onmaxilla bone) surfaces in
a counter-current heat-exchange system.[8] Dogs are capable of prolonged chases, in contrast to the ambush predation of cats, and
these complex turbinates play an important role in enabling this (cats only possess a much smaller and less-developed set of nasal
turbinates).[8] This same complex turbinate structure help conserve water in arid environments.[9] The water conservation and
thermoregulatory capabilities of these well-developed turbinates in dogs may have been crucial adaptations that allowed dogs
(including both domestic dogs and their wild prehistoric gray wolf ancestors) to survive in the harsh Arctic environment and other
[9]
cold areas of northern Eurasia and North America, which are both very dry and very cold.

Reptiles and more primitive synapsids have olfactory turbinates that are involved in sensing smell rather than preventing
desiccation.[10] While the maxilloturbinates of mammals are located in the path of airflow to collect moisture, sensory turbinates in
both mammals and reptiles are positioned farther back and above the nasal passage, away from the flow of air.[11] Glanosuchus has
ridges positioned low in the nasal cavity, indicating that it had maxilloturbinates that were in the direct path of airflow. The
maxilloturbinates may not have been preserved because they were either very thin or cartilaginous. The possibility has also been
raised that these ridges are associated with an olfactory epithelium rather than turbinates.[12] Nonetheless, the possible presence of
maxilloturbinates suggests that Glanosuchus may have been able to rapidly breathe without drying out the nasal passage, and
therefore could have been an endotherm.[6][10][12]

The bones of nasal turbinates are very fragile and seldom survive as fossils. In particular none have been found in fossil birds.[13] But
there is indirect evidence for their presence in some fossils. Rudimentary ridges like those that support respiratory turbinates have
been found in advanced Triassic cynodonts, such as Thrinaxodon and Diademodon. This suggests that they may have had fairly high
metabolic rates.[14][15][16][17] The paleontologist John Ruben and others have argued that no evidence of nasal turbinates has been
found in dinosaurs. All the dinosaurs they examined had nasal passages that they claimed were too narrow and too short to
accommodate nasal turbinates, so dinosaurs could not have sustained the breathing rate required for a mammal-like or bird-like
metabolic rate while at rest, because their lungs would have dried out.[11][18][19] However, objections have been raised against this
argument. Nasal turbinates are absent or very small in some birds, such as ratites, Procellariiformes and Falconiformes. They are also
absent or very small in some mammals, such as anteaters, bats, elephants, whales and most primates, although these animals are fully
endothermic and in some cases very active.[20][21][22][23] Furthermore, ossified turbinate bones have been identified in the
ankylosaurid dinosaur Saichania.[24]

See also

Additional images

Nasal conchae: Normal Nose CT Front Coronal section of nasal Right nasal airway
Blocked/free cross section cavities. passage

Nasal conchae Nasal concha

Notes
1. Anatomy of the Human Body(http://www.bartelby.com/107/223.html) Gray, Henry (1918) The Nasal Cavity.
2. Turbinate Dysfunction: Focus on the role of the inferior turbinates in nasal airway obstruction.(http://www.utmb.edu/o
toref/grnds/Turbinate-2003-0312/Turbinate-2003-0312.htm)S.S. Reddy, et al. Grand Rounds Presentation, UTMB,
Dept. of Otolaryngology
3. Camacho, M., Zaghi, S., Certal, V., Abdullatif, J., Means, C., Acevedo, J., Liu, S., Brietzke, S. E., Kushida, C. A. and
Capasso, R. (2014), Inferior Turbinate classification system, grades 1 to 4: Development and validation study . The
Laryngoscope. doi:10.1002/lary.24923 (https://doi.org/10.1002%2Flary.24923)
4. Reduction/Removal of the Inferior Turbinate (http://www.sinusinfocenter.com/treatment_inferiorTurbinate.html) From
the Sinus Info Center.
5. Houser SM. Surgical Treatment for Empty Nose Syndrome. Archives of Otolaryngology Head & Neck Surgery\ ol
V
133 (No.9) Sep' 2007: 858-863.
6. Zimmer, C. (1994). "The Importance of Noses"(http://discovermagazine.com/1994/aug/theimportanceofn416)
.
Discover. 15 (8).
7. Maloney, S. K.; Dawson, T. J. (1998). "Ventilatory accommodation of oxygen demand and respiratory water loss in a
large bird, the Emu (Dromaius novaehollandiae), and a re-examination of ventilatory allometry for birds".
Physiological Zoology. 71 (6): 712–719. doi:10.1086/515997 (https://doi.org/10.1086%2F515997). PMID 9798259 (h
ttps://www.ncbi.nlm.nih.gov/pubmed/9798259).
8. Wang (2008) p.88.
9. Wang (2008) p.87.
10. Hillenius, W.J. (1994). "Turbinates in therapsids: Evidence for Late Permian origins of mammalian endothermy".
Evolution. 48 (2): 207–229. doi:10.2307/2410089 (https://doi.org/10.2307%2F2410089). JSTOR 2410089 (https://ww
w.jstor.org/stable/2410089). PMID 28568303 (https://www.ncbi.nlm.nih.gov/pubmed/28568303).
11. Ruben, J.A.; Jones, T.D. (2000). "Selective factors associated with the origin of fur and feathers"(http://icb.oxfordjour
nals.org/content/40/4/585.full.pdf+html). American Zoologist. 40 (4): 585–596. doi:10.1093/icb/40.4.585 (https://doi.o
rg/10.1093%2Ficb%2F40.4.585).
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structure". Zoological Journal of the Linnean Society. 147 (4): 473–488. doi:10.1111/j.1096-3642.2006.00226.x(http
s://doi.org/10.1111%2Fj.1096-3642.2006.00226.x) .
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Function". Science. 293 (5531): 850–853. CiteSeerX 10.1.1.629.1744 (https://citeseerx.ist.psu.edu/viewdoc/summar
y?doi=10.1.1.629.1744). doi:10.1126/science.1062681(https://doi.org/10.1126%2Fscience.1062681) .
PMID 11486085 (https://www.ncbi.nlm.nih.gov/pubmed/11486085).
14. Brink, A.S. (1955). "A study on the skeleton ofDiademodon". Palaeontologia Africana. 3: 3–39.
15. Kemp, T.S. (1982). Mammal-like reptiles and the origin of mammals
. London: Academic Press. p. 363.ISBN 978-0-
12-404120-2.
16. Hillenius, W.H. (1992). "The evolution of nasal turbinates and mammalian endothermy".Paleobiology. 18 (1): 17–29.
doi:10.1017/S0094837300012197(https://doi.org/10.1017%2FS0094837300012197) . JSTOR 2400978 (https://www.
jstor.org/stable/2400978).
17. Ruben, J. (1995). "The evolution of endothermy in mammals and birds: from physiology to fossils".
Annual Review of
Physiology. 57: 69–95. doi:10.1146/annurev.ph.57.030195.000441(https://doi.org/10.1146%2Fannurev.ph.57.03019
5.000441). PMID 7778882 (https://www.ncbi.nlm.nih.gov/pubmed/7778882).
18. Ruben, J.A., Jones, T.D., Geist, N.R. and Hillenius, W. J. (November 1997). "Lung structure and ventilation in
theropod dinosaurs and early birds".Science. 278 (5341): 1267–1270. Bibcode:1997Sci...278.1267R (http://adsabs.
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References
Wang, Xiaoming (2008) Dogs: Their Fossil Relatives and Evolutionary HistoryColumbia University Press.
ISBN 9780231509435.

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