Pott's Puffy Tumor: A Case Report on Diagnosis Through Imaging

Pott's puffy tumor (PPT) is a rare but life-threatening complication of chronic sinusitis, although it can be secondary to other entities such as trauma or insect bites. It is characterized by circumscribed frontal swelling associated with a subperiosteal abscess. Imaging plays a crucial role in diagnosis and early identification of complications, some of which can be life-threatening, including intracerebral and intra-orbital complications. We present a case of a 14-year-old male with non-specific frontal pain and swelling, where the diagnosis of PTT was confirmed through imaging studies. Upon admission, the patient exhibited orbital and intracerebral complications, as shown in MRI and CT scans. Treatment involved a combination of antibiotics and sinus surgery, with close monitoring for orbital and intracranial complications.

Case Report: Pott's Edematous Tumor: Complicated Frontal Sinusitis - An Unremembered Diagnosis

Pott’s Puffy tumor, also called Pott’s edematous tumor (PET), is a subperiosteal abscess of the frontal bone, associated with osteomyelitis of the frontal bone. In this paper, we report the case of a 16-year-old patient who presented with headache associated with progressive forehead swelling and fever. Clinical and imaging exams pointed to the hypothesis of PET associated with brain abscess. Patient was submitted to surgical excision of the abscess and treatment of osteomyelitis, with intraoperative findings corroborating the condition. There was a good clinical-radiological recovery associated with prolonged antibiotic therapy and satisfactory follow-up after hospital. PET, which often results from an underdiagnosed or partially treated frontal sinusitis, is a condition that must be promptly recognized and directed to an adequate therapeutic approach due to the risk of serious complications that it entails.

Unusual Presentation of Pott's puffy tumour in a child: our recent experience and review of the literature

Pott's puffy tumour (PPT) is a rarely seen, but highly important, complication of frontal sinusitis. Early recognition followed by prompt imaging and treatment of this condition are essential to improve patient outcomes and prevent complications. This case report describes an atypical presentation of radiologically confirmed PPT in a boy who presented with a 2.5-week history of progressive frontal headache and midline frontal swelling. Flexible nasendoscopy revealed no acute findings. Prompt CT imaging confirmed the diagnosis and early surgical intervention via endoscopic approach with aggressive antibiotic therapy led to good recovery. This case highlights the need to remember PPT in assessing any child or adolescent with a new forehead swelling, with or without sinusitis symptoms. If there is strong clinical suspicion, further imaging should not be delayed. Surgical intervention should be performed as early as possible to prevent intracranial complications; antibiotics alone are not sufficient.

Incidence of Odontogenic Disease in Patients With Pott's Puffy Tumor

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.

Pautas de tratamiento del tumor inflamatorio de Pott. Revisión bibliográfica

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.