Uncinate Spur: Nasal Bony Projection—Significance & Management

An uncinate spur is a bony projection arising from the uncinate process—a hook-shaped bone of the ethmoid bone that forms part of the lateral nasal wall and maxillary sinus drainage pathway. It's a common anatomical variant, frequently seen incidentally on sinus CT or MRI.

Clinical Significance

• Usually asymptomatic—an incidental finding requiring no treatment.
• May contribute to pathology if large or strategically positioned:
  • Narrows the infundibulum (maxillary sinus drainage pathway)
  • Obstructs the middle meatus or ethmoid infundibulum
  • Predisposes to recurrent maxillary sinusitis by impairing mucociliary clearance
  • Causes nasal obstruction or contact-point headaches (sluder's neuralgia)

Diagnosis

• Coronal CT sinus (best for bony detail)
• Nasal endoscopy (visualizes relationship to middle turbinate, infundibulum)

Management

• Asymptomatic: Observation. No surgery for incidental findings.
• Symptomatic (recurrent sinusitis, obstruction):
  • Medical management first: nasal steroids, saline irrigation, antibiotics for acute flares.
  • Endoscopic sinus surgery (FESS): Uncinectomy (removal of uncinate process ± spur) to widen infundibulum, restore drainage. High success rate, low morbidity.

Key Point

An uncinate spur on imaging ≠ disease. Correlate with symptoms. Treat the patient, not the scan.