Background: Usual descriptions indicate three or maximum four nasal turbinates (conchae) attached to the lateral nasal wall. The middle, superior and, occasionally, supreme ones belong to the ethmoid bone. Few authors include in descriptions the concha that Zuckerkandl described as the fourth or supreme ethmoidal turbinate. Despite some inconsistencies in Zuckerkandl's description, the concha bearing his name lies above Santorini's supreme concha, which, in turn, is above Morgagni's superior concha. Few other authors preferred to name Santorini's concha as the first supreme one and Zuckerkandl's concha as the second supreme one.
Methods: We retrospectively documented, with various purposes, the archived cone-beam computed tomography files of 350 patients.
Results: We found in just one case a unilateral sequence of five nasal turbinates. On the opposite side, only four turbinates were detected. Three-dimensional renderizations confirmed that when two supreme turbinates are found, they are joined in a common posterior tail, which, in turn, joins the tail of the superior turbinate.
Conclusions: Co-existence of two supreme conchae could either indicate their origin from different ethmoturbinals, or from the split of a commonly unique supreme one. Zuckerkandl's concha deserves therefore to be considered when anatomical descriptions, or studies, are delivered.