Frontal sinusitis caused by first and second secondary middle turbinates co-existing with an accessory middle turbinate

The anatomy of the nasal cavity and the paranasal sinuses is complex. After widespread use of endoscopes and computed tomography, many variations have been described. Secondary and accessory middle turbinates (AMTs) can mimic the real middle turbinate. These variations may arise during embryological development. I believe that detailed knowledge of anomalies of the sinonasal tract is critical for successful management, and important in enabling the surgeon to perform safe surgery. Failure to recognize the variants could lead to inadvertent damage to the orbital lamina papyracea during surgery. Knowledge and correct description of anatomical variations of the turbinates by use of computed tomography images will aid achievement of correct diagnosis and surgical management and avoidance of potential complications during endoscopic procedures. To the best of my knowledge, this is the first report in the world literature of sinusitis caused by first and second secondary middle turbinates co-existing with an AMT.