Aeration of the concha is called concha bullosa regardless of the amount and location of the aeration. Middle concha pneumatization is very frequent, and its incidence rate according to the literature is between 14% and 53.6%. Various types of middle concha such as pneumatized, paradoxical, bifurcate, trifurcate, secondary, and accessory have been defined; however, the most frequently observed variation is the pneumatization of the middle concha. In our case, a male patient presented to our clinic with complaints about difficulty breathing through the nose and decrease in the olfaction. The endoscopic examination showed that his right middle concha had grown enough to extend toward the front of the lower concha, and the left middle and lower meatuses were infested by polyps. The paranasal computed tomographic scan of the patient showed that the left middle concha had maxillary sinus invasion at an amount that was enough to fill 25% of the maxillary sinus. In this case presentation, the middle concha pneumatization presenting with maxillary sinus invasion, which we believe is the first case in the literature, is presented as accompanied by the literature.