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Shabih S, Lewis B, Koenig ZA, Brooke SM, Meltzer H, Uygur HS. Pott Puffy Tumor Secondary to Cranial Vault Reconstruction in a Patient With Metopic Craniosynostosis. J Craniofac Surg 2023:00001665-990000000-01164. [PMID: 37938063 DOI: 10.1097/scs.0000000000009815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Accepted: 08/26/2023] [Indexed: 11/09/2023] Open
Abstract
Pott puffy tumor (PPT) is defined as a subperiosteal abscess of the anterior wall of the frontal sinus associated with underlying frontal osteomyelitis. PPT affects all age groups but occurs predominantly in adolescents. The potential etiologies include rhinosinusitis, a history of direct trauma to the forehead, odontogenic disease, intranasal drug abuse, diabetes, or other immunocompromised states. We introduce a case of a 6-year-old boy with a medical history of anterior cranial vault remodeling presenting with localized forehead swelling. Computed tomography imaging demonstrated mucosal thickening and a region of dehiscence in the wall of the frontal sinus; the presence of midline subperiosteal abscess was consistent with a diagnosis of PPT. Due to concerns for intracranial involvement, we utilized removal and replacement of the anterior wall of the frontal sinus, complete removal of sinus mucosa, and frontal sinus obliteration with bilateral peri-cranial flaps. To the best of our knowledge, this is the first case description of a PPT secondary to cranial vault reconstruction in a patient with metopic craniosynostosis.
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Affiliation(s)
| | | | - Zachary A Koenig
- West Virginia University Division of Plastic & Reconstructive Surgery
| | | | - Hal Meltzer
- West Virginia University Department of Neurosurgery, Morgantown, WV
| | - Halil S Uygur
- West Virginia University Division of Plastic & Reconstructive Surgery
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Nguyen DK, Idicula W, Nguyen T, Demke J, Cordero J, Dundar Y. Pott's Puffy: First Shot is the Best Shot. J Craniofac Surg 2023; Publish Ahead of Print:00001665-990000000-00815. [PMID: 37307535 DOI: 10.1097/scs.0000000000009451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2023] [Accepted: 03/30/2023] [Indexed: 06/14/2023] Open
Abstract
OBJECTIVE Low incidence of Pott's Puffy tumor (PPT) has caused studying risk factors and recurrences of the disease to be difficult. We used the comparatively increased incidence at our institution to evaluate potential risk factors for the disease process itself and prognostic factors for recurrence of the disease. METHODS Single institutional retrospective chart review identified 31 patients from 2010 to 2022 with PPT compared with a control group of 20 patients with either chronic rhinosinusitis or recurrent sinusitis. Patient mean age of PPT was 42 (range of 5 to 90) with the majority of the patient population as male (74%) and Caucasian (68%) in the setting of rural West Texas. Patient mean age of the control group was 50.7 (range of 30-78) with majority of patient population as male (55%) and Caucasian (70%). Interventions studied were functional endoscopic sinus surgery (FESS), FESS with trephination, and cranialization with or without FESS to compare prognostic factors for recurrence rates of PPT. These patients' prognostic risk factors for recurrence and risk factors to develop PPT were analyzed using Analysis of Variance (ANOVA) χ2 statistical analysis with Fischer exact testing. RESULTS Mean age was 42 years (range of 5-90) with the majority of the PPT patient population as male (74%) and Caucasian (68%) with an overall incidence of about 1 in 300,000. Pott's Puffy tumor patients were significantly favored in the younger and male population compared with the control patients. Risk factors of no prior allergy diagnosis, previous trauma, medication allergy to penicillin class or cephalosporin class, and lower body mass index were significant in the PPT population compared with the control group. Significant prognostic factors for recurrence of PPT were prior history of sinus surgery and operative treatment choice. Fifty percent (3/6) of patients with prior sinus surgery had recurrence of PPT. Of our 4 treatment options (FESS, FESS with trephination, FESS with cranialization, or cranialization alone), ;FESS had a recurrence of PPT of 0% (0/13), FESS with trephination had a recurrence of PPT of 50% (3/6), FESS with cranialization had a recurrence of PPT of 11% (1/9), and cranizalization alone had a recurrence of PPT of 0% (0/3). Of note, postop chronic rhinosinusitis was seen in 46% (6/13) of FESS alone, 17% (1/6) with FESS with trephination, 0% (0/9) with FESS with cranialization, and 33% (1/3) with just cranialization alone. CONCLUSIONS Pott's Puffy tumor patients were younger and predominately male when compared to the control patients. No prior allergy diagnosis, previous trauma history, medication allergy to penicillin class or cephalosporin class, and lower body mass index are risk factors for PPT. There are 2 prognostic factors that predict recurrence of PPT: first operative treatment choice and prior sinus surgery. History of prior sinus surgery tends to increase the recurrence of PPT. The first operative treatment plan is the best shot at definitively treating PPT. Correct management surgically can prevent recurrence of PPT as well as long-term recurrence of chronic rhinosinusitis. With early diagnosis and mild disease, FESS is sufficient to prevent recurrence of PPT but chronic sinusitis may continue to occur if frontal sinus outflow track is not well opened. If considering trephination, a definitive cranialization may be more suited for more advanced disease since our study showed 50% of recurrence of PPT with trephination and FESS along with 17% chronic sinusitis long term. More advanced diseases with higher WBCs and intracranial extension do better with more aggressive surgical management with a cranialization with or without FESS which shows to reduce rates of PPT recurrence significantly.
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Affiliation(s)
- Daniel K Nguyen
- Department of Otolaryngology, School of Medicine, Texas Tech University Health Sciences Center, Lubbock, TX
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Madala S, Pilli DA, Akkineni A, Pusuluri SNM. A Rare Case of Occipital Subdural Abscess of Rhinogenic Origin: Case Report. Indian J Otolaryngol Head Neck Surg 2023; 75:909-912. [PMID: 37275101 PMCID: PMC10235282 DOI: 10.1007/s12070-022-03131-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2022] [Accepted: 07/10/2022] [Indexed: 10/14/2022] Open
Abstract
In the present day scenario complications arising from sinusitis are rare, since the introduction of antibiotics. However Sinusitis and its complications are still existing and masking of symptoms due to inadequate dosage and duration of antibiotics, which is life threatening and if neglected may result in high morbidity and mortality. This case has been presented for its rare presentation of parafalcine abscess of left occipital lobe of middle cranial fossa, which is secondary to frontal sinusitis. A 40 year old male patient was admitted in ICU with chief complaints of fever for 3 days, headache and neck stiffness for 2 days and altered sensorium for 1 day. Computed tomography showed both frontals, ethmoids and maxillary sinusitis on the left side. Patient was given conservative treatment and showed partial improvement of symptoms. On repeat CT brain (after 2 weeks) showed abscess parasagittally in left occipital lobe. Neurosurgeon aspirated abscess through parasagittal approach. Later the patient referred to the ENT department and ESS (endoscopic sinus surgery) DRAF II procedure done for clearance of frontal sinus to avoid recurrence of intracranial complications.
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Affiliation(s)
- Sudhakara Madala
- Departement of ENT, Dr. Pinnamaneni Siddhartha Institute of Medical Sciences and Research Foundation, Gannavaram, India
- D. No: 7-93/3, Flat no: 3105, KVNM Dolphin Estates, Pantakaluva road, Kanuru, Vijayawada, Andhra Pradesh 520007 India
| | - Devi Amulya Pilli
- Departement of ENT, Dr. Pinnamaneni Siddhartha Institute of Medical Sciences and Research Foundation, Gannavaram, India
- D.No: 46-18-16, Dr. TSK hospitals - Tesla scan centre, Dr Thota Sivakumar Hospital Street, Danavaipeta, Rajahmundry, Andhra Pradesh 533101 India
| | - Anusha Akkineni
- Departement of ENT, Dr. Pinnamaneni Siddhartha Institute of Medical Sciences and Research Foundation, Gannavaram, India
| | - SN Murthy Pusuluri
- Departement of ENT, Dr. Pinnamaneni Siddhartha Institute of Medical Sciences and Research Foundation, Gannavaram, India
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Sideris G, Davoutis E, Panagoulis E, Maragkoudakis P, Nikolopoulos T, Delides A. A Systematic Review of Intracranial Complications in Adults with Pott Puffy Tumor over Four Decades. Brain Sci 2023; 13:brainsci13040587. [PMID: 37190552 DOI: 10.3390/brainsci13040587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2023] [Revised: 03/27/2023] [Accepted: 03/29/2023] [Indexed: 04/03/2023] Open
Abstract
The purpose of this study is to investigate the risk factors of intracranial complications in adult patients with Pott Puffy Tumor (PPT). A systematic review was conducted of clinical studies from January 1983 to December 2022 that reported on PPT adult patients. The full-text articles were reviewed for the patients’ ages, sex, cultured organisms, surgical procedures, clinical sequalae, and underlying diseases that may affect the onset of intracranial complications in PPT adult patients. A total of 106 studies were included. Medical data were reviewed for 125 patients (94 males, 31 females). The median age was 45 years. A total of 52% had comorbidities, mostly head trauma (24.5%), sinus/neurosurgical operations (22.4%), immunosuppression conditions (13.3%), diabetes mellitus (9.1%), cocaine use (7.1%), or dental infections (6.1%). A total of 28 cultures revealed Streptococcus (22.4%), 24 contained staphylococci (19.2%), and 22 cultures contained other pathogens (17.6%). An amount of 30.4% developed intracranial complications, with the most common being epidural abscesses or empyemas (55.3%), as well as subdural (15.7%) and extradural lesions (13.2%). Age, DM, and immunosuppression conditions are significantly associated with intracranial complications (p < 0.001, p = 0.018 and p = 0.022, respectively). Streptococcus infection is associated with intracranial complications (p = 0.001), although Staphylococcus and other microorganisms are not. Surgical intervention, mainly ESS, and broad-spectrum antibiotics remain the cornerstones of treatment.
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Affiliation(s)
- Giorgos Sideris
- 2nd ENT Department, Attikon University Hospital, 124 62 Athens, Greece
| | | | | | | | | | - Alexander Delides
- 2nd ENT Department, Attikon University Hospital, 124 62 Athens, Greece
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Muacevic A, Adler JR, Chaudhry A, Agnelli M. A Tumor Treated With Antibiotics: A Rare Case. Cureus 2022; 14:e32819. [PMID: 36694498 PMCID: PMC9863745 DOI: 10.7759/cureus.32819] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/22/2022] [Indexed: 12/24/2022] Open
Abstract
Pott's puffy tumor, a rare condition, is an osteomyelitis involving the frontal bone with accompanying subperiosteal abscess. Patients typically present with swelling of the scalp and forehead, headache, fever, tenderness of the frontal sinus, and nasal discharge. MRI is the modality of choice for diagnosis and assessment. The standard of care is incision and drainage with long-course antibiotics. The prognosis is excellent; however, complications from a hematogenous spread can lead to meningitis or epidural spaces if not treated properly.
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Abbas MS, Al-Smadi AS, Smitt M, Geimadi A, Luqman AW. The rare presentation of a frontal mucocele complicated by a Pott’s puffy tumor and an epidural-cutaneous fistula: illustrative case. JOURNAL OF NEUROSURGERY: CASE LESSONS 2022; 4:CASE22134. [PMID: 36164672 PMCID: PMC9514262 DOI: 10.3171/case22134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Accepted: 06/15/2022] [Indexed: 11/10/2022]
Abstract
BACKGROUND Frontal mucoceles develop due to accumulation of mucoid secretions within the frontal sinuses. They can lead to serious consequences with further expansion and destruction of the surrounding bones or infection that might spread intracranially. OBSERVATIONS The authors present a case of a 37-year-old male with a frontal mucocele and the rare presentation of Pott’s puffy tumor and an epidural-cutaneous fistula, as well as a literature review of previously reported cases of epidural cutaneous fistula and sinocutaneous fistula, their predisposing factors, and their management. LESSONS A mucocele is a benign entity that can rarely present with potentially significant complications. Open surgery is required in patients who have frontal sinus posterior wall involvement, osteomyelitis, or intracranial involvement.
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Affiliation(s)
| | | | - Marisa Smitt
- Neurosurgery Department, Detroit Medical Center, Detroit, Michigan
| | | | - Ali W. Luqman
- Neurosurgery Department, Detroit Medical Center/Wayne State University, Detroit, Michigan; and
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Carvalho dos Santos P, Costa P, Carvalho I, Sousa C. Complicaciones de la rinosinusitis aguda. Una revisión clínica radiológica. RADIOLOGIA 2022. [DOI: 10.1016/j.rx.2022.03.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Rohde RL, North LM, Murray M, Khalili S, Poetker DM. Pott's puffy tumor: A comprehensive review of the literature. Am J Otolaryngol 2022; 43:103529. [PMID: 35700606 DOI: 10.1016/j.amjoto.2022.103529] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 06/06/2022] [Indexed: 11/01/2022]
Abstract
PURPOSE Pott's puffy tumor (PPT) is a rare clinical entity characterized by osteomyelitis of the frontal bone with subperiosteal abscess collection. The frequency of reported cases of PPT in the literature has increased in recent years. Previous reviews of PPT exist primarily in the form of small, retrospective case series and anecdotal case reports. Therefore, the aim of this study is to provide the literature's largest comprehensive, up-to-date review of the essential clinical findings, diagnostic modalities, microbiologic considerations, and treatment approaches utilized in the management of PPT, both in pediatric and adult populations. MATERIALS AND METHODS We searched MEDLINE, PubMed, and Embase databases for English-language studies published from January 1950 through January 30, 2022. The authors reviewed all cases of PPT, focusing specifically on those describing therapeutic management of PPT. A total of 321 patients were included, consisting of 318 patients (from 216 articles) and an additional 3 adult cases from our institution. RESULTS PPT most often results from untreated rhinosinusitis, as well as direct head trauma, substance use, and odontogenic disease. Infections are classically polymicrobial with an anaerobe-predominant microbiome. Both CT and MRI imaging modalities are commonly obtained for presurgical assessment of sinusitis and intracranial extension. The core of treatment is an early and aggressive approach to prevent long-term complications. A significant association exists between surgical management and clinical outcomes for patients with PPT. Recent literature suggests endoscopic sinus surgery is essential for successful disease resolution. CONCLUSIONS PPT is an important and relatively morbid disease process that is often underrecognized and misdiagnosed at presentation due to its variable clinical presentation. Management of PPT includes both antimicrobial therapy and surgical intervention. Determination of the optimal approach depends on patient clinical features including age, history of prior endoscopic sinus surgery, and presence of intracranial involvement on presentation. An individualized, targeted, and interdisciplinary approach to the treatment of PPT is critical for successful disease resolution.
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Affiliation(s)
- Rebecca L Rohde
- Department of Otolaryngology & Communication Sciences, Medical College of Wisconsin, Milwaukee, WI, United States of America; Zablocki Veteran's Association Medical Center, Division of Surgery, Milwaukee, WI, United States of America
| | - Lauren M North
- Department of Otolaryngology & Communication Sciences, Medical College of Wisconsin, Milwaukee, WI, United States of America; Zablocki Veteran's Association Medical Center, Division of Surgery, Milwaukee, WI, United States of America
| | - Molly Murray
- Department of Otolaryngology & Communication Sciences, Medical College of Wisconsin, Milwaukee, WI, United States of America
| | - Sammy Khalili
- Department of Otorhinolaryngology, Aurora Neuroscience Innovation Institute, Aurora St. Luke's Medical Center, Milwaukee, WI, United States of America
| | - David M Poetker
- Department of Otolaryngology & Communication Sciences, Medical College of Wisconsin, Milwaukee, WI, United States of America; Zablocki Veteran's Association Medical Center, Division of Surgery, Milwaukee, WI, United States of America.
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Salemans R, Bijkerk E, Sawor J, Piatkowski A. Misdiagnosed epidermoid cyst appears Potts Puffy Tumor: A case report and literature review. Int J Surg Case Rep 2022; 94:106975. [PMID: 35461175 PMCID: PMC9046797 DOI: 10.1016/j.ijscr.2022.106975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Revised: 03/14/2022] [Accepted: 03/24/2022] [Indexed: 11/22/2022] Open
Abstract
Introduction Although nowadays rare, Potts Puffy Tumor (PPT) is a rare but serious diagnosis characterized by osteomyelitis of the frontal bone. The introduction of broad-spectrum antibiotics made PPT an uncommon diagnosis in modern medicine, and it is mostly seen as a complication of frontal sinusitis in children and adolescents. Case presentation We report a case of PPT in an elderly man with a sudden and increasing swelling of the forehead, which was initially diagnosed as an epidermoid cyst. Subsequent surgical exploration revealed osteomyelitis of the underlying frontal bone. Medical imaging by computed tomography (CT) and magnetic resonance imaging (MRI) was done, and treatment with Functional Endoscopic Sinus Surgery (FESS) and reconstructive surgery of the frontal bone was conducted. Discussion PPT is a rare, yet serious condition which is usually seen as a complication of chronic sinusitis which causes osteomyelitis and a subperiosteal abscess. Despite the atypical presentation of symptoms, the reported case underlines the importance of rapid deployment of medical imaging, referral, and administration of broad-spectrum antibiotics. Furthermore, surgical intervention is indicated in most cases. When left untreated, PPT can result in severe intracranial complications. Conclusion The diagnosis PTT is still relevant and may have a nonspecific presentation. A persisting epidermoid cyst after drainage should lead to the suspicion of a PTT. Immediate imaging and adequate treatment are required to prevent serious, potentially lethal intracranial complications. Rare conditions can still manifest in modern medicine. Potts Puffy Tumor may present as atypical epidermoid cyst. Osteomyelitis of the frontal bone can lead to serious intracranial complications.
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Affiliation(s)
- R Salemans
- Department of Plastic and Reconstructive Surgery, VieCuri Medical Center, Venlo, the Netherlands
| | - E Bijkerk
- Department of Plastic and Reconstructive Surgery, VieCuri Medical Center, Venlo, the Netherlands
| | - J Sawor
- Department of Plastic and Reconstructive Surgery, VieCuri Medical Center, Venlo, the Netherlands; Department of Plastic and Reconstructive Surgery, Maastricht University Medical Center, the Netherlands.
| | - A Piatkowski
- Department of Plastic and Reconstructive Surgery, VieCuri Medical Center, Venlo, the Netherlands; Department of Plastic and Reconstructive Surgery, Maastricht University Medical Center, the Netherlands
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Pott Puffy Tumor Caused by Dental Infection: A Case Report and Literature Review. J Craniofac Surg 2022; 33:e127-e130. [DOI: 10.1097/scs.0000000000008010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Acuña J, Shockey D, Adhikari S. The Use of Point-of-care Ultrasound in the Diagnosis of Pott's Puffy Tumor: A Case Report. Clin Pract Cases Emerg Med 2021; 5:422-424. [PMID: 34813434 PMCID: PMC8610465 DOI: 10.5811/cpcem.2021.6.52726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Accepted: 06/08/2021] [Indexed: 11/11/2022] Open
Abstract
INTRODUCTION Pott's puffy tumor (PPT) is a rare clinical disease characterized by forehead swelling from a subperiosteal abscess coupled with frontal bone osteomyelitis. It is often associated with severe complications and poor outcomes if left undiagnosed; thus, rapid recognition is crucial. Point-of-care ultrasound (POCUS) may provide an alternative pathway to diagnosis. It can be performed rapidly at the bedside and assist in early screening of patients, identifying those with high suspicion for PPT and prioritizing imaging and consultation. CASE REPORT A 59-yghb ar-old-male presented to the emergency department for evaluation of a "lump" on his forehead. He recently had a bifrontal craniotomy to de-bulk a polyp burden in an effort to manage his recurrent sinusitis. To further characterize the mass, a POCUS examination was performed by the treating emergency physician. The examination found a subcutaneous, hypoechoic fluid collection extending superficially along the frontal bone. A discontinuity in the surface of the frontal bone was visualized through which the collection appeared to extend. Given the heightened concern for PPT based on the POCUS examination findings, otolaryngology service was consulted and the patient was admitted for further imaging and treatment. CONCLUSION Pott's puffy tumor is a rare diagnosis that has the potential for life-threatening complications. Timely diagnosis is imperative. Point-of-care ultrasound can easily be used to help identify patients with suspicion for PPT in the acute care setting and influence patient management with regard to obtaining further imaging and plans for early consultation.
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Affiliation(s)
- Josie Acuña
- The University of Arizona Tucson, Department of Emergency Medicine, Tucson, Arizona
| | - Daniel Shockey
- The University of Arizona Tucson, Department of Emergency Medicine, Tucson, Arizona
| | - Srikar Adhikari
- The University of Arizona Tucson, Department of Emergency Medicine, Tucson, Arizona
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Imaging of orbital infectious and inflammatory disease in children. Pediatr Radiol 2021; 51:1149-1161. [PMID: 33978792 DOI: 10.1007/s00247-020-04745-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Revised: 04/28/2020] [Accepted: 05/24/2020] [Indexed: 10/21/2022]
Abstract
Most acute nontraumatic periorbital and intraorbital pathologies in pediatric patients have an underlying infectious or inflammatory etiology, and imaging frequently plays a key role in the workup and management of these children. In this paper we review the clinical presentation and imaging findings in children with some of the most common infectious and inflammatory diseases involving the orbit. Basic relevant anatomy and imaging findings on various imaging modalities are also reviewed.
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Orlandi RR, Kingdom TT, Smith TL, Bleier B, DeConde A, Luong AU, Poetker DM, Soler Z, Welch KC, Wise SK, Adappa N, Alt JA, Anselmo-Lima WT, Bachert C, Baroody FM, Batra PS, Bernal-Sprekelsen M, Beswick D, Bhattacharyya N, Chandra RK, Chang EH, Chiu A, Chowdhury N, Citardi MJ, Cohen NA, Conley DB, DelGaudio J, Desrosiers M, Douglas R, Eloy JA, Fokkens WJ, Gray ST, Gudis DA, Hamilos DL, Han JK, Harvey R, Hellings P, Holbrook EH, Hopkins C, Hwang P, Javer AR, Jiang RS, Kennedy D, Kern R, Laidlaw T, Lal D, Lane A, Lee HM, Lee JT, Levy JM, Lin SY, Lund V, McMains KC, Metson R, Mullol J, Naclerio R, Oakley G, Otori N, Palmer JN, Parikh SR, Passali D, Patel Z, Peters A, Philpott C, Psaltis AJ, Ramakrishnan VR, Ramanathan M, Roh HJ, Rudmik L, Sacks R, Schlosser RJ, Sedaghat AR, Senior BA, Sindwani R, Smith K, Snidvongs K, Stewart M, Suh JD, Tan BK, Turner JH, van Drunen CM, Voegels R, Wang DY, Woodworth BA, Wormald PJ, Wright ED, Yan C, Zhang L, Zhou B. International consensus statement on allergy and rhinology: rhinosinusitis 2021. Int Forum Allergy Rhinol 2021; 11:213-739. [PMID: 33236525 DOI: 10.1002/alr.22741] [Citation(s) in RCA: 390] [Impact Index Per Article: 130.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Accepted: 11/09/2020] [Indexed: 02/06/2023]
Abstract
I. EXECUTIVE SUMMARY BACKGROUND: The 5 years since the publication of the first International Consensus Statement on Allergy and Rhinology: Rhinosinusitis (ICAR-RS) has witnessed foundational progress in our understanding and treatment of rhinologic disease. These advances are reflected within the more than 40 new topics covered within the ICAR-RS-2021 as well as updates to the original 140 topics. This executive summary consolidates the evidence-based findings of the document. METHODS ICAR-RS presents over 180 topics in the forms of evidence-based reviews with recommendations (EBRRs), evidence-based reviews, and literature reviews. The highest grade structured recommendations of the EBRR sections are summarized in this executive summary. RESULTS ICAR-RS-2021 covers 22 topics regarding the medical management of RS, which are grade A/B and are presented in the executive summary. Additionally, 4 topics regarding the surgical management of RS are grade A/B and are presented in the executive summary. Finally, a comprehensive evidence-based management algorithm is provided. CONCLUSION This ICAR-RS-2021 executive summary provides a compilation of the evidence-based recommendations for medical and surgical treatment of the most common forms of RS.
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Affiliation(s)
| | | | | | | | | | - Amber U Luong
- University of Texas Medical School at Houston, Houston, TX
| | | | - Zachary Soler
- Medical University of South Carolina, Charleston, SC
| | - Kevin C Welch
- Feinberg School of Medicine, Northwestern University, Chicago, IL
| | | | | | | | | | - Claus Bachert
- Ghent University, Ghent, Belgium.,Karolinska Institute, Stockholm, Sweden.,Sun Yatsen University, Gangzhou, China
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - David A Gudis
- Columbia University Irving Medical Center, New York, NY
| | - Daniel L Hamilos
- Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | | | - Richard Harvey
- University of New South Wales and Macquarie University, Sydney, New South Wales, Australia
| | | | | | | | | | - Amin R Javer
- University of British Columbia, Vancouver, British Columbia, Canada
| | | | | | | | | | | | | | | | | | | | | | - Valerie Lund
- Royal National Throat Nose and Ear Hospital, UCLH, London, UK
| | - Kevin C McMains
- Uniformed Services University of Health Sciences, San Antonio, TX
| | | | - Joaquim Mullol
- IDIBAPS Hospital Clinic, University of Barcelona, Barcelona, Spain
| | | | | | | | | | | | | | | | | | | | - Alkis J Psaltis
- University of Adelaide, Adelaide, South Australia, Australia
| | | | | | | | - Luke Rudmik
- University of Calgary, Calgary, Alberta, Canada
| | - Raymond Sacks
- University of New South Wales, Sydney, New South Wales, Australia
| | | | | | | | | | | | | | | | | | | | | | | | | | - De Yun Wang
- National University of Singapore, Singapore, Singapore
| | | | | | | | - Carol Yan
- University of California San Diego, La Jolla, CA
| | - Luo Zhang
- Capital Medical University, Beijing, China
| | - Bing Zhou
- Capital Medical University, Beijing, China
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Paw E, Ong CTW, Vangaveti V. Pott's puffy tumour in an immunosuppressed adult: case report and systematic review of literature. J Surg Case Rep 2020; 2020:rjaa528. [PMID: 33391653 PMCID: PMC7769593 DOI: 10.1093/jscr/rjaa528] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2020] [Accepted: 11/20/2020] [Indexed: 11/12/2022] Open
Abstract
This case is of a 34-year-old immunocompromised male with Pott’s puffy tumour, which was treated with antibiotics and endoscopic sinus surgery. Pott’s puffy tumour is typically a complication of frontal sinusitis in children and immunocompromise can be a precipitating factor. A search was conducted of Embase, Medline, CINAHL, Cochrane, Google Scholar, Informit and Scopus of ‘Pott’s Puffy’ and variations of this phrase. Initial 804 records were reviewed by title, abstract and full text. Of the unique papers identified, 155 only included paediatric patients and 128 included adult patients. After title, abstract and full-text review of 13 papers were identified describing Pott’s puffy tumour in immunocompromised patients. Immunosuppression was noted as a risk factor in only a small number of cases, with diabetes mellitus being the most common. A few cases did note immunosuppression due to newer immunomodulatory agents being used for treatment of autoimmune conditions.
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Affiliation(s)
- Ekta Paw
- James Cook University, College of Medicine and Dentistry, Townsville, Queensland 4811, Australia
| | - Chelsea T W Ong
- Mater Hospital Pimlico, Department of Surgery, Townsville, Queensland 4812, Australia
| | - Venkat Vangaveti
- James Cook University, College of Medicine and Dentistry, Townsville, Queensland 4811, Australia
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15
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Sideris G, Delides A, Proikas K, Papadimitriou N. Pott Puffy Tumor in Adults: The Τiming of Surgical Ιntervention. Cureus 2020; 12:e11781. [PMID: 33409028 PMCID: PMC7779183 DOI: 10.7759/cureus.11781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Pott’s puffy tumor (PPT) represents a rare complication of frontal sinusitis, and it is considered as a subperiosteal abscess of the frontal bone based on osteomyelitis. We report two adult PPT patients and discuss the treatment plan as well as the correct timing of surgical intervention. Clinical examination revealed sinusitis with puss, and imaging findings showed bony erosion of the dorsal wall of the frontal sinus in both patients. In case 1, a “wait and see” approach was followed with remission of the patient’s symptoms, and a Draf IIb type was performed 21 days after discharge. In case 2, worsening of symptoms led to surgical drainage through a Lynch incision followed by 20 days of intravenous antibiotic treatment. Then a Draf type IIa was performed. Both patients received antibiotic therapy over the course of six weeks and had full recovery. We highlight the importance of the correct timing of surgical intervention as it is depended on the clinical and radiological findings. The timing to performing radical drainage surgery including external or endoscopic frontal sinus surgery is not determined in the literature. Worsening of common symptoms and neurological signs in adult PPT patients means by default an immediate surgical intervention. Reduction of symptoms and antibiotic treatment response means that surgery should be delayed and performed in a surgical field free of inflammation.
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Affiliation(s)
- Giorgos Sideris
- 2nd ENT Department, Attikon University Hospital, National and Kapodistrian University of Athens, Athens, GRC
| | - Alexander Delides
- 2nd ENT Department, School of Medicine, Attikon University Hospital, National and Kapodistrian University of Athens, Athens, GRC
| | - Konstantinos Proikas
- 2nd ENT Department, Attikon University Hospital, National and Kapodistrian University of Athens, Athens, GRC
| | - Nikolaos Papadimitriou
- 2nd ENT Department, Attikon University Hospital, National and Kapodistrian University of Athens, Athens, GRC
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16
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Bean H, Min Z, Como J, Bhanot N. Pott's puffy tumor caused by Actinomyces naeslundii. IDCases 2020; 22:e00974. [PMID: 33033689 PMCID: PMC7533312 DOI: 10.1016/j.idcr.2020.e00974] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 09/24/2020] [Accepted: 09/24/2020] [Indexed: 11/24/2022] Open
Abstract
Pott’s puffy tumor is characterized by forehead swelling from subperiosteal abscess and frontal bone osteomyelitis. It is encountered mainly in children; rarely in adults. When it does occur in the latter population, the most common risk factors include head trauma, sinusitis, or cocaine abuse. Generally, the organisms thought to be involved include streptococci, staphylococci and oral anaerobic flora. We present a case of a 53 year old female who presented with forehead swelling of 3 month duration after a dental procedure, found to be secondary to Actinomyces naeslundii. Actinomyces is a very rare etiology of this disease and has been reported only twice earlier in the literature. We present an uncommon infectious disease along with summary of clinical characteristics of this entity in the adult population.
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Affiliation(s)
- Holly Bean
- Division of Infectious Disease, Allegheny Health Network, PA, 15212, United States
| | - Zaw Min
- Division of Infectious Disease, Allegheny Health Network, PA, 15212, United States
| | - James Como
- Division of Infectious Disease, Allegheny Health Network, PA, 15212, United States
| | - Nitin Bhanot
- Division of Infectious Disease, Allegheny Health Network, PA, 15212, United States
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17
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Abstract
Pott's puffy tumor (PPT) is a rare subperiosteal abscess of the frontal bone with osteomyelitis, which most commonly affects adolescents as a complication of frontal sinusitis or head trauma. The Authors describe a case of development of a PPT in a woman who abused of cocaine for at least five years and presented with a gradually enlarging mass of the forehead. The patient was treated surgically through combined endoscopic and open approach and medically with antibiotic therapy. The PPT, as rare complication of intranasal cocaine abuse, was described until now in four patients. Even rare it can be a fearsome complication, making of fundamental importance an early diagnosis and a correct management.
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18
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Song MW, Montovano M, Kubiak A, Khalid S, Ellner J. Pott's Puffy Tumor: Intracranial Extension Not Requiring Neurosurgical Intervention. Cureus 2020; 12:e10106. [PMID: 33005524 PMCID: PMC7522185 DOI: 10.7759/cureus.10106] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Pott’s puffy tumor, typified by a subperiosteal abscess underlying the frontal bone, is an uncommonly encountered clinical entity that can occur in the setting of local trauma or secondary to frontal sinusitis. Diagnosis can be challenging, as cultures may be sterile, and the condition must be differentiated from neoplasm and superficial and soft tissue infection. Although more common in the pediatric population, Pott’s puffy tumor must remain on the differential with a high index of suspicion in adult patients who fit the clinical picture. Early diagnosis with CT or MRI and therapeutic medical and surgical intervention are crucial as intracranial complications, such as abscess and empyema can occur and may be fatal. We present an adult patient with a history of inhaled drug abuse who presented with Pott’s puffy tumor with meningitis and bifrontal epidural abscesses at presentation. There is evidence in the literature that management of sinus-related intracranial epidural abscess with antibiotic therapy and adequate surgical or endoscopic surgical drainage may bypass the need for neurosurgical intervention, as was the case here.
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Affiliation(s)
- Michael W Song
- Infectious Diseases, Rutgers New Jersey Medical School, Newark, USA
| | | | | | - Shaza Khalid
- Infectious Diseases, Rutgers New Jersey Medical School, Newark, USA
| | - Jerrold Ellner
- Infectious Diseases, Rutgers New Jersey Medical School, Newark, USA
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19
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Nallani R, Wichova H, McAroy JL, Chiu AG, Villwock JA. Incidence of Odontogenic Disease in Patients With Pott's Puffy Tumor. J Oral Maxillofac Surg 2020; 79:389-397. [PMID: 32890475 DOI: 10.1016/j.joms.2020.08.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Revised: 07/31/2020] [Accepted: 08/04/2020] [Indexed: 11/17/2022]
Abstract
PURPOSE Osteomyelitis with subperiosteal abscess of the frontal bone, or Pott's puffy tumor (PPT), is a rare but life-threatening condition. The relationship of concurrent dental disease to PPT has not been well described. This study sought to delineate the incidence of odontogenic disease in PPT, especially in cases where there is no history of facial trauma or prior frontal sinus surgery. METHODS A retrospective chart review of patients diagnosed with PPT between 2010 and 2019 was carried out. Demographics, pertinent medical history, surgical procedures performed, and microbial cultures and antibiotics used were extracted for analysis. Maxillofacial computed tomography scans were reviewed for presence of odontogenic disease. RESULTS A total of 17 patients were identified. Four had documented history of frontal bone trauma; 3 had previous frontal sinus surgery. Seven (41%) had documented odontogenic disease on initial radiology reports; however, upon dentist review, 16 (94%) had various pathology visible on their computed tomography scans. Twelve of these 16 patients had no previous frontal sinus trauma or surgery. Eight patients (47%) had only ipsilateral maxillary or ethmoid inflammation respective to PPT on computed tomography. Seventy-six percent of patients underwent endoscopic sinus surgery. Of 14 patients with cultures collected at the time of surgery, 7 (50%) had polymicrobial growth and 6 (43%) had anaerobic growth. CONCLUSIONS The incidence of odontogenic disease in this population of PPT was 94%. In the absence of a history of frontal bone trauma or frontal sinus surgery, underlying dental origin should be suspected in cases of PPT. Initial radiology reports may not document all identifiable dental pathology. Therefore, patients presenting with PPT should undergo comprehensive evaluation, including an oral cavity and dental examination, and potential referral to dental colleagues.
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Affiliation(s)
- Rohit Nallani
- Clinical Research Fellow, Department of Otolaryngology-Head and Neck Surgery, University of Kansas Medical Center, Kansas City, KS.
| | - Helena Wichova
- Resident, Department of Otolaryngology-Head and Neck Surgery, University of Kansas Medical Center, Kansas City, KS
| | - Jennifer L McAroy
- Volunteer Faculty Affiliate, Department of Otolaryngology-Head and Neck Surgery, University of Kansas Medical Center, Kansas City, KS
| | - Alexander G Chiu
- Department Head, Department of Otolaryngology-Head and Neck Surgery, University of Kansas Medical Center, Kansas City, KS
| | - Jennifer A Villwock
- Assistant Professor, Department of Otolaryngology-Head and Neck Surgery, University of Kansas Medical Center, Kansas City, KS
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20
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Salom-Coveñas C, Benito-Navarro JR, Gutiérrez-Gallardo A, Porras-Alonso E. Pautas de tratamiento del tumor inflamatorio de Pott. Revisión bibliográfica. REVISTA ORL 2020. [DOI: 10.14201/orl.23104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Introducción y objetivo: El objetivo de este estudio es proporcionar una revisión actualizada del tratamiento médico y quirúrgico en pacientes con abscesos subperiósticos secundarios a la osteomielitis del hueso frontal. Método: Se realizó una búsqueda en la base de datos PubMed, BVS (biblioteca virtual en salud España) y Scopus de las distintas opciones terapéuticas del tumor de Pott. La revisión se realizó siguiendo los criterios PRISMA. Resultados: Se seleccionaron 20 artículos en la búsqueda bibliográfica. Un total de 30 pacientes (24 varones, con media de edad de 27 años) fueron revisados. En un 90% la causa fue una rinosinusitis crónica, seguida por traumatismos locales. En la mayoría de los casos se realizó un drenaje endoscópico tipo Draf 2 (60%), 5 pacientes fueron sometidos a un Draf 3, tres a un Draf 1 y sólo uno a un Draf 2B. Un paciente fue tratado con sinuplastia con balón y otro con craneotomía externa aislada. Todos los pacientes tenían antibióticos orales o intravenosos de duración variable; aunque predomina el esquema terapéutico de vancomicina y ceftriaxona endovenosa durante 6 semanas. No hubo más complicaciones después de la intervención endoscópica sinusal. La presencia de fístulas, cicatrizaron sin necesidad de desbridamiento quirúrgico o cierre. Discusión: el tumor inflamatorio de Pott es una patología muy infrecuente. Debido a la rareza de la patología, muchos casos han sido infradiagnosticados desembocando en complicaciones intracraneales. El abordaje externo ha sido el tratamiento de elección durante años; actualmente se aboga por un abordaje endonasal guiada en ocasiones por neuronavegador sumado a la antibioticoterapia correspondiente durante un largo periodo de tiempo. Conclusiones: La mayoría de los casos de tumor inflamatorio de Pott pueden manejarse endoscópicamente. La disponibilidad de instrumentos en ángulo motorizados, videos de alta definición y sistemas de guía de imágenes han proporcionado a los otorrinolaringólogos una alternativa creíble a las técnicas tradicionales. Además, la biodisponibilidad mejorada de los antibióticos puede obviar la necesidad de una craneotomía y drenajes externos.
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Michalik M, Samet A, Podbielska-Kubera A, Savini V, Międzobrodzki J, Kosecka-Strojek M. Coagulase-negative staphylococci (CoNS) as a significant etiological factor of laryngological infections: a review. Ann Clin Microbiol Antimicrob 2020; 19:26. [PMID: 32498711 PMCID: PMC7271473 DOI: 10.1186/s12941-020-00367-x] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Accepted: 05/25/2020] [Indexed: 12/18/2022] Open
Abstract
This review article shows that coagulase-negative staphylococci (CoNS) are widely responsible for laryngological diseases. General characteristics of CoNS infections are shown in the introduction, and the pathogenicity in terms of virulence determinants, biofilm formation and genetic regulation mechanisms of these bacteria is presented in the first part of the paper to better display the virulence potential of staphylococci. The PubMed search keywords were as follows: CoNS and: nares infections, nasal polyps, rhinosinusitis, necrosing sinusitis, periprosthetic joint infection, pharyngitis, osteomyelitis of skull and neck bones, tonsillitis and recurrent tonsillitis. A list of laryngological infections and those related to skull and neck bones was presented with descriptions of the following diseases: rhinosinusitis, necrotizing sinusitis, nasal polyps, nares and nasal skin infections, periprosthetic joint infections, osteomyelitis, pharyngitis, and tonsillitis. Species identification and diagnostic problems challenging for diagnosticians are presented. Concluding remarks regarding the presence of CoNS in humans and their distribution, particularly under the effect of facilitating factors, are mentioned.
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Affiliation(s)
| | | | | | - Vincenzo Savini
- Clinical Microbiology and Virology, Spirito Santo Hospital, Pescara, PE, Italy
| | - Jacek Międzobrodzki
- Department of Microbiology, Faculty of Biochemistry, Biophysics and Biotechnology, Jagiellonian University, Kraków, Poland
| | - Maja Kosecka-Strojek
- Department of Microbiology, Faculty of Biochemistry, Biophysics and Biotechnology, Jagiellonian University, Kraków, Poland.
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22
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SALOM-COVEÑAS C, BENITO-NAVARRO JR, GUTIÉRREZ-GALLARDO A, PORRAS-ALONSO E. Tumor inflamatorio de pott. Descripción de un caso. REVISTA ORL 2020. [DOI: 10.14201/orl.23019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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23
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Pendolino AL, Koumpa FS, Zhang H, Leong SC, Andrews PJ. Draf III frontal sinus surgery for the treatment of Pott's puffy tumour in adults: our case series and a review of frontal sinus anatomy risk factors. Eur Arch Otorhinolaryngol 2020; 277:2271-2278. [PMID: 32346755 PMCID: PMC7335370 DOI: 10.1007/s00405-020-05980-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Accepted: 04/10/2020] [Indexed: 11/22/2022]
Abstract
Purpose We present our case series of four adult patients with Pott’s puffy tumour (PPT), successfully treated with Draf III over a mean period of 11 months. A critical review of the literature is also provided. Methods A retrospective review of patients undergoing Draf III for PPT from January 2018 to January 2019 was performed. Results Four consecutive male patients ranging from 26 to 62 years, with a mean age of 49.5 ± 16.3 years, undergoing Draf III for Pott’s puffy tumour were included. Two patients had a Kuhn type IV frontal cell narrowing the frontonasal pathway and presented without previous sinus surgery, whereas the other two had previous sinus surgery. The success rate of the operation was 100% with an average length of follow-up of 11 months (range 5–18). Conclusion In our experience, the Draf III procedure is a highly effective treatment of PPT. In particular, we have demonstrated it to be very effective in accessing highly positioned Kuhn type IV cells.
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Affiliation(s)
- Alfonso Luca Pendolino
- Department of ENT, Royal National Ent and Eastman Dental Hospitals, 47-49 Huntley St Bloomsbury, London, WC1E 6DG, UK. .,Ear Institute, UCL, London, UK.
| | - Foteini Stefania Koumpa
- Department of ENT, Royal National Ent and Eastman Dental Hospitals, 47-49 Huntley St Bloomsbury, London, WC1E 6DG, UK
| | - Henry Zhang
- Department of ENT, Royal National Ent and Eastman Dental Hospitals, 47-49 Huntley St Bloomsbury, London, WC1E 6DG, UK
| | - Samuel C Leong
- Skull Base Unit, Department of Otorhinolaryngology-Head and Neck Surgery, Aintree University Hospital NHS Foundation Trust, Liverpool, UK
| | - Peter J Andrews
- Department of ENT, Royal National Ent and Eastman Dental Hospitals, 47-49 Huntley St Bloomsbury, London, WC1E 6DG, UK.,Ear Institute, UCL, London, UK
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24
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Olzowy B, Al-Nawas B, Havel M, Karbach J, Müller R. Calculated parenteral initial treatment of bacterial infections: Infections in the ear, nose, throat and mouth and jaw area. GMS INFECTIOUS DISEASES 2020; 8:Doc14. [PMID: 32373439 PMCID: PMC7186809 DOI: 10.3205/id000058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
This is the sixth chapter of the guideline "Calculated initial parenteral treatment of bacterial infections in adults - update 2018" in the 2nd updated version. The German guideline by the Paul-Ehrlich-Gesellschaft für Chemotherapie e.V. (PEG) has been translated to address an international audience. The chapter deals with the antibacterial treatment of more severe infections of the ear, the nose, the throat and the maxillofacial region, including odontogenic and salivary gland infections.
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Affiliation(s)
| | - Bilal Al-Nawas
- Klinik für Mund-, Kiefer- und Gesichtschirurgie, Universitätsmedizin Mainz, Germany
| | - Miriam Havel
- Klinik und Poliklinik für HNO-Heilkunde, Klinikum der Universität München, Munich, Germany
| | - Julia Karbach
- Klinik für Mund-, Kiefer- und Gesichtschirurgie, Universitätsmedizin Mainz, Germany
| | - Rainer Müller
- Klinik und Poliklinik für Hals-, Nasen- und Ohrenheilkunde, Universitätsklinikum Carl Gustav Carus Dresden, Germany
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25
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Koltsidopoulos P, Papageorgiou E, Skoulakis C. Acute sinusitis complicated with Pott puffy tumour. CMAJ 2019; 191:E165. [PMID: 30745402 DOI: 10.1503/cmaj.181025] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Affiliation(s)
- Petros Koltsidopoulos
- Department of Otolaryngology (Koltsidopoulos), General Hospital of Volos, Volos, Greece; Departments of Ophthalmology (Papageorgiou) and Otolaryngology (Skoulakis), University Hospital of Larissa, Larissa, Greece
| | - Eleni Papageorgiou
- Department of Otolaryngology (Koltsidopoulos), General Hospital of Volos, Volos, Greece; Departments of Ophthalmology (Papageorgiou) and Otolaryngology (Skoulakis), University Hospital of Larissa, Larissa, Greece
| | - Charalampos Skoulakis
- Department of Otolaryngology (Koltsidopoulos), General Hospital of Volos, Volos, Greece; Departments of Ophthalmology (Papageorgiou) and Otolaryngology (Skoulakis), University Hospital of Larissa, Larissa, Greece
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26
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[Pott's puffy tumour: innovative technique in calvarial reconstruction]. The Journal of Laryngology & Otology 2019; 133:1005-1008. [PMID: 31587674 DOI: 10.1017/s0022215119002093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Pott's puffy tumour is a rare complication of sinusitis. This osteomyelitis can affect the outer and inner tables of the frontal sinus. The treatment of Pott's puffy tumour combines medical and surgical approaches. Surgical approaches have traditionally been open, but endoscopic techniques have been adopted recently in select cases. The bony defect from debridement can be left alone, or closed with autografts or allografts. OBJECTIVE To describe a technique for the reconstruction of a large skull vault after the debridement of extensive osteomyelitis of the anterior cranial vault. METHODS Modified distraction osteogenesis is used in the cranial vault, to induce new bone formation. This is customarily used to lengthen long bones. The advantages of this technique include avoiding autologous grafts or alloplastic cranioplasty in the infected surgical bed, and allowing primary closure. RESULTS Early post-operative imaging results have been encouraging, with no reported complications. CONCLUSION Modified distraction osteogenesis is a novel technique in the primary reconstruction of calvarial bone.
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Linton S, Pearman A, Joganathan V, Karagama Y. Orbital abscess as a complication of Pott's puffy tumour in an adolescent male. BMJ Case Rep 2019; 12:12/7/e229664. [PMID: 31315845 DOI: 10.1136/bcr-2019-229664] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Pott's puffy tumour (PPT) is a known complication of frontal sinusitis. It is defined as subperiosteal abscess formation due to osteomyelitis of the frontal bone presenting as a forehead swelling. It is a life-threatening condition that can lead to intracranial and intraorbital complications. Gadolinium-enhanced MRI and contrast CT scan are the best modalities to localise and define the collection, in addition to confirming disease extension. Once confirmed by imaging and depending on disease extension, management of PPT requires a multidisciplinary team approach and depends on the local provision of surgical care. Following surgical drainage of the abscess cavity, a prolonged course of antibiotics is required postoperatively to treat the underlying osteomyelitis.
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Affiliation(s)
- Stefan Linton
- ENT, Central Manchester University Hospitals NHS Foundation Trust, Manchester, Greater Manchester, UK
| | - Alexander Pearman
- ENT, Central Manchester University Hospitals NHS Foundation Trust, Manchester, Greater Manchester, UK
| | - Varajini Joganathan
- Oculoplastics, Central Manchester University Hospitals NHS Foundation Trust Education and Training, Manchester, UK
| | - Yakubu Karagama
- ENT, Central Manchester University Hospitals NHS Foundation Trust, Manchester, Greater Manchester, UK
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28
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Min HJ, Kim KS. Frontocutaneous Fistula Secondary to Pott's Puffy Tumor. EAR, NOSE & THROAT JOURNAL 2019; 99:NP101-NP102. [PMID: 31189353 DOI: 10.1177/0145561319856858] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Hyun Jin Min
- Department of Otorhinolaryngology-Head and Neck Surgery, 65542Chung-Ang University College of Medicine, Seoul, Korea
| | - Kyung Soo Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, 65542Chung-Ang University College of Medicine, Seoul, Korea
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29
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Dusu K, Chandrasekharan D, Al Yaghchi C, Quiney R. A huge Pott's puffy tumour secondary to pansinusitis. BMJ Case Rep 2019; 12:e229755. [PMID: 30948418 PMCID: PMC6453345 DOI: 10.1136/bcr-2019-229755] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/19/2019] [Indexed: 11/04/2022] Open
Affiliation(s)
- Keli Dusu
- Head and Neck Surgery, University College London Hospitals NHS Foundation Trust, London, UK
| | | | | | - Robert Quiney
- ENT, Royal National Throat Nose and Ear Hospital, London, UK
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30
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Wang K, Li S, Xiang W, Ming Y, Peng T, Wang H, Chen L, Zhou J. Cerebral Granuloma Mimicking Malignant Neoplasm in Patient with Seizures 21 Years After Head Trauma. World Neurosurg 2019; 127:629-632.e1. [PMID: 30794983 DOI: 10.1016/j.wneu.2019.01.286] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2018] [Revised: 01/28/2019] [Accepted: 01/30/2019] [Indexed: 11/30/2022]
Abstract
BACKGROUND Chronic posttraumatic cerebral granuloma is a rare, delayed complication of traumatic brain injury. Because of its late onset of symptoms and atypical appearance, the correct diagnosis of this rare lesion is difficult. CASE DESCRIPTION A 49-year-old man presented with seizures, which occurred 21 years after open right forehead trauma. Imaging techniques, such as magnetic resonance imaging and magnetic resonance spectroscopy, which indicated a malignant neoplasm, revealed a mass lesion on the right frontal lobe, invading the dura and partial frontal bone. The patient underwent total removal of the lesion and titanium mesh cranioplasty, simultaneously, due to invasion of the mass lesion into the skull. However, the postoperative histopathologic diagnosis was chronic inflammatory granuloma. At 1-year follow-up, he did not have any discomfort and epilepsy did not recur. CONCLUSIONS Chronic cerebral granuloma should be considered in the differential diagnosis of a novel or recurrent mass detected in patients with a history of traumatic brain injury or prior surgery. Moreover, the retained foreign bodies in the superficial or nonfunctional area of the brain should be thoroughly examined and removed at the time of injury, particularly in open brain trauma.
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Affiliation(s)
- Ke Wang
- Department of Neurosurgery, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, P. R. China
| | - Shenjie Li
- Department of Neurosurgery, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, P. R. China
| | - Wei Xiang
- Department of Neurosurgery, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, P. R. China
| | - Yang Ming
- Department of Neurosurgery, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, P. R. China
| | - Tao Peng
- Department of Neurosurgery, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, P. R. China
| | - Haorun Wang
- Department of Neurosurgery, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, P. R. China
| | - Ligang Chen
- Department of Neurosurgery, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, P. R. China.
| | - Jie Zhou
- Department of Neurosurgery, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, P. R. China
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Recurrent Pottʼs Puffy Tumor Treated With Anterior Skull Base Resection With Reconstruction of the Anterolateral Thigh Flap. J Craniofac Surg 2019; 30:e94-e96. [DOI: 10.1097/scs.0000000000005100] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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32
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Olmaz B, Cingoz M, Akdogan E, Kandemirli SG. Correlation of imaging and intraoperative findings in Pott’s puffy tumour. Scott Med J 2018; 64:25-29. [DOI: 10.1177/0036933018803787] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Introduction Pott’s puffy tumour is characterised by frontal bone osteomyelitis accompanied by subperiosteal abscess. It can be further complicated by intracranial extension of the infectious process. Case presentation A 12-year-old boy initially presented with signs and imaging findings of pan-sinusitis. Despite antibiotic therapy, there was progressive swelling of the forehead region. Subsequent imaging studies revealed osteomyelitis of frontal bone, subcutaneous abscess and extension into intracranial space. The abscesses were surgically drained, and craniectomy for osteomyelitis was carried out. Conclusion The initial symptoms of Pott’s puffy tumour can be subtle, and antibiotic use may mask the underlying sinister involvement of intracranial structures. Imaging plays an important role both in diagnosis and detection of possible intracranial complications.
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Affiliation(s)
- Burak Olmaz
- MD, Department of Neurosurgery, Sirnak State Hospital, Turkey
| | - Mehmet Cingoz
- MD, Department of Radiology, Sirnak State Hospital, Turkey
| | - Emin Akdogan
- MD, Department of Radiology, Sirnak State Hospital, Turkey
| | - Sedat G Kandemirli
- MD, Department of Radiology, Faculty of Medicine, Uludag University, Turkey
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Abstract
Fusobacterium infections and Lemierre syndrome are traditionally associated with pharyngitis. We report 3 cases of Fusobacterium sinusitis that resulted in Pott puffy tumor. One of these cases also had Lemierre Syndrome. We encourage expansion of the clinical spectrum of Lemierre syndrome to include complicated Fusobacterium sinusitis.
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Podolsky-Gondim GG, Santos MV, Carneiro VM, Pires Augusto L, Da Costa Pacheco Neto R, Santos de Oliveira R. Neurosurgical Management of Pott's Puffy Tumor in an Obese Adolescent with Asthma: Case Report with a Brief Review of the Literature. Cureus 2018; 10:e2836. [PMID: 30131929 PMCID: PMC6101458 DOI: 10.7759/cureus.2836] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Pott’s puffy tumor is a rare and severe complication of frontal sinusitis, characterized by the progressive swelling of the frontal soft tissues secondary to a subperiosteal abscess. Radiological imaging with ultrasound, computed tomography (CT), and magnetic resonance imaging (MRI) are important diagnostic tools in establishing diagnosis and treatment planning. Early surgery along with intravenous antibiotics are required in order to achieve a good recovery. The authors report a case of Pott’s puffy tumor in an obese 14-year-old male, with a previous history of asthma and a chronic use of steroids, treated with neurosurgical debridement followed by a combined course of intravenous (IV) and oral antibiotics, who had a favorable outcome upon long-term follow-up. In addition, a brief review of the current medical literature was performed for a discussion on the diagnostic and therapeutic features of this pathology.
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Affiliation(s)
- Guilherme G Podolsky-Gondim
- Division of Neurosurgery, Department of Surgery and Anatomy, Ribeirão Preto Clinics Hospital, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, BRA
| | - Marcelo V Santos
- Division of Pediatric Neurosurgery, Department of Surgery and Anatomy, Ribeirão Preto Clinics Hospital, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, BRA
| | - Vinícius M Carneiro
- Division of Neurosurgery, Department of Surgery and Anatomy, Ribeirão Preto Clinics Hospital, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, BRA
| | - Lucas Pires Augusto
- Division of Pediatric Neurosurgery, Department of Surgery and Anatomy, Ribeirão Preto Clinics Hospital, Ribeirão Preto Medical School, University of São Paulo, Ribeirao Preto , BRA
| | - Romilto Da Costa Pacheco Neto
- Division of Pediatric Neurosurgery, Department of Surgery and Anatomy, Ribeirão Preto Clinics Hospital, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, BRA
| | - Ricardo Santos de Oliveira
- Division of Pediatric Neurosurgery, Department of Surgery and Anatomy, Ribeirão Preto Clinics Hospital, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, BRA
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Hibi A, Amakusa Y. Intracranial subdural abscess with polymicrobial infections due to frontal sinusitis in an adolescent: life-threatening complication of a common disease. Clin Case Rep 2018; 6:516-521. [PMID: 29531731 PMCID: PMC5838286 DOI: 10.1002/ccr3.1355] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2017] [Revised: 11/17/2017] [Accepted: 12/10/2017] [Indexed: 01/28/2023] Open
Abstract
Intracranial abscess is one of the most serious complications of frontal sinusitis, particularly among adolescents, even in the absence of odontogenic infection. Polymicrobial infections due to anaerobes are common. Because antibiotic therapy alone is usually ineffective, early endoscopic sinus surgery is the key for infection control and good clinical outcomes.
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Affiliation(s)
- Arata Hibi
- Division of Nephrology and RheumatologyDepartment of Internal MedicineKariya Toyota General Hospital5‐15, Sumiyoshi‐choKariyaAichi448‐8505Japan
| | - Yoshinobu Amakusa
- Department of NeurologyKariya Toyota General Hospital5‐15, Sumiyoshi‐choKariyaAichi448‐8505Japan
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38
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Abstract
OBJECTIVES Pott puffy tumor (PPT) is defined as soft tissue swelling of the forehead due to subperiosteal edema, accumulation of pus, or granulation tissue. It is associated with osteomyelitis of frontal bone secondary to frontal sinusitis. Pott puffy tumor can be complicated by preseptal and orbital cellulitis and intracranial infection. METHODS Six patients diagnosed with and treated for PPT in Pediatric Clinic of Uludag University Faculty of Medicine from 2010 to 2015 were reviewed retrospectively. Age, sex, presenting symptoms and signs, laboratory and radiological findings, as well as intracranial complications and treatment modalities of all patients were evaluated. RESULTS The authors present 6 pediatric patients of PPT, 5 males and 1 female with a mean age of 11 years (age range, 7-18 years). All patients presented with headache, fever, and tender frontal swelling. Two of the patients had epidural abscess and 1 had preseptal orbital cellulitis in addition to PPT. All of them had computed tomography scan and/or magnetic resonance imaging. Endoscopic sinus surgery was performed in 4 patients and 2 patients underwent neurosurgical intervention with antibiotherapy. CONCLUSIONS Pott puffy tumor may be associated with potentially dangerous intracranial complications. Early diagnosis and treatment are essential to reduce morbidity and mortality. Imaging plays an important role in the diagnosis of the disease and the detection of its complications.
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Perić A, Milojević M, Ivetić D. A Pott's Puffy Tumor Associated with Epidural - Cutaneous Fistula and Epidural Abscess: Case Report. Balkan Med J 2017; 34:284-287. [PMID: 28443599 PMCID: PMC5450872 DOI: 10.4274/balkanmedj.2016.1304] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Background: Pott’s puffy tumour is characterized by a fluctuate swelling of the frontal region as a result of osteomyelitis of the frontal bone. This inflammatory lesion may propagate endocranially, resulting in acute meningitis, epidural abscess, subdural empyema, cavernous sinus trombophlebitis, cerebritis, and frontal lobe abscess of the brain. Case Report: We present an unusual case of a 33-year-old man suffering from Pott’s puffy tumour whose condition was further complicated by a draining epidural-cutaneous fistula and an epidural abscess. We confirmed the diagnosis by contrast-enhanced computed tomography scanning and magnetic resonance imaging of the head. After intense antibiotic treatment, we performed a combined endoscopic and external surgical approach with drainage of abscesses, evacuation of pus and bone sequestrate and excision of fistulous lesion. The treatment was prolonged with four weeks’ antibiotic administration. Conclusion: Subperiosteal abscess of the frontal bone is an extremely rare complication of frontal sinusitis. This lesion may propagate endocranially, resulting in dangerous intracranial inflammatory lesions. Early diagnosis, medication and surgical therapy are very important in reducing morbidity and mortality.
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Affiliation(s)
- Aleksandar Perić
- Department of Otorhinolaryngology, Military Medical Academy School of Medicine, Belgrade, Serbia
| | - Milanko Milojević
- Department of Otorhinolaryngology, Military Medical Academy School of Medicine, Belgrade, Serbia
| | - Dražen Ivetić
- Department of Neurosurgery, Military Medical Academy School of Medicine, Belgrade, Serbia
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Leong SC. Minimally Invasive Surgery for Pott's Puffy Tumor: Is It Time for a Paradigm Shift in Managing a 250-Year-Old Problem? Ann Otol Rhinol Laryngol 2017; 126:433-437. [PMID: 28376662 DOI: 10.1177/0003489417698497] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
INTRODUCTION The aim of this study was to review the clinical outcomes and efficacy of endoscopic sinus surgery (ESS) in the management of Pott's puffy tumor (PPT). METHODS Literature PubMed review using a combination of MeSH terms and keywords was undertaken, combined with a single surgeon case series of 3 patients. RESULTS A total of 29 (20 males, median age 25 years) cases were reviewed. The most common etiology was acute frontal sinusitis (62%), followed by a history of chronic rhinosinusitis (28%). Two patients presented with concomitant preseptal cellulitis and cutaneous fistula each, while another had pneumocephalus. The majority of cases (59%) had Draf 1 procedure. Three cases had Draf 3 procedure. Five cases were successfully treated by sinus balloon sinuplasty. Postoperatively, most patients had either oral or intravenous antibiotics of varying duration. There were no further complications following ESS. Both fistulas healed without requiring surgical debridement or closure. CONCLUSION Some PPT cases can be managed endoscopically. The availability of powered angled instruments, high-definition video, and image guidance systems have provided the modern otolaryngologists with a credible alternative to traditional techniques. Furthermore, improved bioavailability of modern antibiotics may obviate the need for craniotomy and external drains.
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Affiliation(s)
- Samuel C Leong
- 1 Skull Base Unit, Department of Otorhinolaryngology - Head and Neck Surgery, Aintree University Hospital NHS Foundation Trust, Liverpool, UK
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Soberón GS, Prado HM, Sadek A, Plowes O, Arrieta JR, Figueroa V. Proposal for Staging of Inflammatory Lesions in the Frontal Region. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2016. [DOI: 10.1016/j.otoeng.2016.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Low SAW, Hussain A, Gill HS, Monteiro E, Liu ES. Pott's puffy tumour presenting as a necrotic eyelid lesion. Can J Ophthalmol 2016; 52:e25-e28. [PMID: 28237166 DOI: 10.1016/j.jcjo.2016.06.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2016] [Accepted: 06/18/2016] [Indexed: 11/30/2022]
Affiliation(s)
- Stephanie A W Low
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ont.
| | - Ahsen Hussain
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ont
| | - Harmeet S Gill
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ont
| | - Eric Monteiro
- Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, Ont
| | - Eugene S Liu
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ont
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Abstract
The frontal sinus is the most complex of all paranasal sinuses. Given its proximity to the cranial vault and orbit, frontal sinus pathology can progress to involve these structures and lead to significant morbidity, or even mortality. Surgical management of the frontal sinus is technically challenging. Various open and endoscopic surgical techniques are available to the otolaryngologist. This article presents an overview of the major disease entities that affect the frontal sinus, with a special emphasis on treatment principles and surgical management.
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van der Poel NA, Hansen FS, Georgalas C, Fokkens WJ. Minimally invasive treatment of patients with Pott's puffy tumour with or without endocranial extension - a case series of six patients: Our Experience. Clin Otolaryngol 2016; 41:596-601. [PMID: 26382235 DOI: 10.1111/coa.12538] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/10/2015] [Indexed: 11/30/2022]
Affiliation(s)
- N A van der Poel
- Otorhinolaryngology, Academic Medical Centre, Amsterdam, Netherlands.
| | - F S Hansen
- Otorhinolaryngology, Central Military Hospital, Amsterdam, Netherlands
| | - C Georgalas
- Otorhinolaryngology, Academic Medical Centre, Amsterdam, Netherlands
| | - W J Fokkens
- Otorhinolaryngology, Academic Medical Centre, Amsterdam, Netherlands
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Sugiyama A, Kobayashi M, Moriishi H, Tanaka H, Mitsuyoshi R, Matsunaga T, Kuwabara S. Pneumocephalus associated with Pott's puffy tumor. J Neurol Sci 2016; 362:196-7. [PMID: 26944146 DOI: 10.1016/j.jns.2016.01.056] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2015] [Revised: 01/24/2016] [Accepted: 01/25/2016] [Indexed: 11/30/2022]
Affiliation(s)
- Atsuhiko Sugiyama
- Department of Neurology, Asahi General Hospital, Chiba, Japan; Department of Neurology, Graduate School of Medicine, Chiba University, Chiba, Japan.
| | | | - Hanako Moriishi
- Department of General Internal Medicine, Asahi General Hospital, Chiba, Japan
| | - Hajime Tanaka
- Department of General Internal Medicine, Asahi General Hospital, Chiba, Japan
| | - Ryoto Mitsuyoshi
- Department of Otolaryngology, Asahi General Hospital, Chiba, Japan
| | | | - Satoshi Kuwabara
- Department of Neurology, Graduate School of Medicine, Chiba University, Chiba, Japan
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Tatsumi S, Ri M, Higashi N, Wakayama N, Matsune S, Tosa M. Pott's Puffy Tumor in an Adult: A Case Report and Review of Literature. J NIPPON MED SCH 2016; 83:211-214. [DOI: 10.1272/jnms.83.211] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Satomi Tatsumi
- Department of Dermatology, Nippon Medical School Tama Nagayama Hospital
| | - Min Ri
- Department of Dermatology, Nippon Medical School Tama Nagayama Hospital
| | - Naoyuki Higashi
- Department of Dermatology, Nippon Medical School Tama Nagayama Hospital
| | - Nozomu Wakayama
- Department of Otolaryngology, Nippon Medical School Musashi Kosugi Hospital
| | - Shoji Matsune
- Department of Otolaryngology, Nippon Medical School Musashi Kosugi Hospital
| | - Mamiko Tosa
- Department of Plastic and Reconstructive Surgery, Nippon Medical School Musashi Kosugi Hospital
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Soudry E, Hwang PH. Acute Frontal Sinusitis. THE FRONTAL SINUS 2016. [PMCID: PMC7178852 DOI: 10.1007/978-3-662-48523-1_6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
Uncomplicated acute frontal sinusitis (AFS) is most often associated with an antecedent viral upper respiratory tract infection. Bacterial infection is suspected if symptoms are persistent for at least 10 days.
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Soberón GS, Prado HM, Sadek A, Plowes O, Arrieta JR, Figueroa V. Proposal for staging of inflammatory lesions in the frontal region. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2015; 67:288-92. [PMID: 26589487 DOI: 10.1016/j.otorri.2015.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2015] [Revised: 06/29/2015] [Accepted: 07/21/2015] [Indexed: 11/25/2022]
Abstract
Frontal swelling can be due to multiple etiologies, including: mucocele, Pott's puffy tumor, fibro osseous lesions, benign and malignant neoplasms of the nose and paranasal sinuses, intracranial lesions, and metastasis. The objective of this study was to describe the clinical protocol used for the diagnosis of patients presented with frontal swelling and the proposal for staging of inflammatory lesions. We performed an observational retrospective analysis. We found 7 cases of patients with frontal swelling: 4 cases secondary to inflammatory pathology (3 Potts puffy tumors and one frontal mucocele), and 3 cases secondary to neoplasms (one benign and 2 malignant neoplasms). It's very important to consider the wide differential diagnosis that can present as frontal swelling, from inflammatory pathologies secondary to possible advanced infections of the paranasal sinuses to invasive malignant neoplasms. We propose a system of staging of frontal inflammatory lesions.
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Affiliation(s)
- Galo S Soberón
- Departamento de Otorrinolaringología y Cirugía de Cabeza y Cuello, Hospital General Dr. Manuel Gea González, Distrito Federal, México
| | - Héctor M Prado
- Departamento de Otorrinolaringología y Cirugía de Cabeza y Cuello, Hospital General Dr. Manuel Gea González, Distrito Federal, México.
| | - Andrés Sadek
- Departamento de Otorrinolaringología y Cirugía de Cabeza y Cuello, Hospital General Dr. Manuel Gea González, Distrito Federal, México
| | - Olga Plowes
- Departamento de Otorrinolaringología y Cirugía de Cabeza y Cuello, Hospital General Dr. Manuel Gea González, Distrito Federal, México
| | - José R Arrieta
- Departamento de Otorrinolaringología y Cirugía de Cabeza y Cuello, Hospital General Dr. Manuel Gea González, Distrito Federal, México
| | - Vladimir Figueroa
- División de Neurocirugía, Hospital General Dr. Manuel Gea González, Distrito Federal, México
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Affiliation(s)
- Stephen L Ball
- Department of ENT Surgery, Freeman Hospital, Newcastle upon Tyne, Tyne & Wear, UK Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, Tyne & Wear, UK
| | - Sean Carrie
- Department of ENT Surgery, Freeman Hospital, Newcastle upon Tyne, Tyne & Wear, UK
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Urík M, Machač J, Šlapák I, Hošnová D. Pott's puffy tumor: a rare complication of acute otitis media in child: a case report. Int J Pediatr Otorhinolaryngol 2015; 79:1589-91. [PMID: 26148429 DOI: 10.1016/j.ijporl.2015.06.029] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2015] [Accepted: 06/19/2015] [Indexed: 11/18/2022]
Abstract
To describe a rare case of Potts' puffy tumor (PPT) in the zygomatic area, which developed as a complication of acute otitis media in a 6-year-old child. To date, only one case of PPT has been described in the literature as a complication of latent mastoiditis in an adult, and one case of PPT as a complication of acute mastoiditis in a 10-year-old child. Urgent surgical intervention, including evacuation of the purulent lesion, removal of inflamed soft tissue and osteolysis of the involved bone, and antromastoidectomy, intravenous treatment with broad-spectrum antibiotics, including G+, G-, anaerobes and fungi, and local therapy.
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Affiliation(s)
- Milan Urík
- Department of Paediatric Otorhinolaryngology, Faculty of Medicine, Masaryk University and Faculty Hospital, Brno, Černopolní 9, 61300, Czech Republic.
| | - Josef Machač
- Department of Paediatric Otorhinolaryngology, Faculty of Medicine, Masaryk University and Faculty Hospital, Brno, Černopolní 9, 61300, Czech Republic
| | - Ivo Šlapák
- Department of Paediatric Otorhinolaryngology, Faculty of Medicine, Masaryk University and Faculty Hospital, Brno, Černopolní 9, 61300, Czech Republic
| | - Dagmar Hošnová
- Department of Paediatric Otorhinolaryngology, Faculty of Medicine, Masaryk University and Faculty Hospital, Brno, Černopolní 9, 61300, Czech Republic
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