The antiquity of Concha Bullosa: a new case from ancient Sicily and a systematic review of the literature

Concha Bullosa (CB) is an anatomical variant of the ostiomeatal complex often leading to pathological conditions, rarely reported in scientific literature. We present a new CB case identified on an adult male skull from the Baucina necropolis (Sicily, Italy, 7th–5th centuries BCE), along with a comprehensive review of the literature. The skull (Bau 23) comes from commingled human remains found in a cave tomb of Sicanian tradition. Both macroscopic examination and CT-Scan imaging were employed for diagnostic analysis. A lamellar-type CB with right middle turbinate pneumatization and septal deviation was identified, along with a small osteoma associated with sinusitis in the left frontal sinus. A narrative review, conducted across major academic databases, identified 269 individuals with CB, involving 350 affected turbinates, mostly in adults of both sexes. The review highlights the extreme rarity of CB diagnoses, particularly for the pre-Common Era periods. The rarity of such diagnoses in ancient remains appears to be linked to nasal fragility, poor preservation, taphonomic damage, and frequent underdiagnosis of subtle variants. Despite the limitations posed by the commingled nature of the assemblage, this case highlights the value of systematically identifying and reporting CB in archaeological contexts, in order to improve our understanding of its bioarchaeological and paleoepidemiological significance.